Dog / Puppy Adoption Application Please complete the form on this page. Name of the dog you are interested in*Family InformationName* First Last Email* Home PhoneWork PhoneCell PhoneAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this address the location where the foster dog will be living?*YesNoAddress where dog will be living* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Housing*OwnRentLive with parentsType*HouseCondoApartmentMobile HomeLandlord's NamePhone*Landlord's Approval*Is your landlord aware that you may be adopting a dog and have they approved it?YesNoList the name and ages of everyone in the householdclick the + to add more rowsNameAge Why are you getting a dog?*Is everyone in your household in favor of adopting a dog?*YesNoPlease explainWhat is your household activity level?*LowModerateActiveVery ActiveIf you currently own any other petsInformation on other petsPlease list any other pets that currently live with you, including age, species/breed, sex, and if they are altered.click the + to add more rowsSpecies/BreedAgeSexAltered (Y/N) Has (Have) your current dog(s) been introduced to the dog you are considering adopting?YesNoAre your current dog(s) up to date on all of their vaccinations?YesNoDog Living Arrangements and CareWill the dog be:* Indoors Outdoors Indoors/Outdoors Dog Run Where will the dog sleep?* Inside Garage Outside Other Explain - where will dog sleep*Who will be responsible for feeding the dog each day?*How many hours per day will the dog be alone?0 - 22 - 44 - 66 - 8over 8Where will the dog stay when you are not at home?*HouseGarageOutsideOther (please explain)Where will dog stay when alone*Will the dog be left unattended with children?*YesNoPlease explain*Who will take care of your dog while you are on vacation?*If you must relocate what will you do with your dog?*Most dogs require regular exercise - who will provide this?*In what family activities will your dog be included?*Are you getting a dog for protection?*YesNoExplain your reason for wanting a dog for protection*What activity level would you like your dog to have?*LowModerateActiveVery ActiveIs anyone in your family allergic to pets?*YesNoPlease describe allergy issues*Do you have a fenced garden?*Do you understand that you will be responsible for caring for your foster dog until they are adopted and that can take months?YesNoHow tall is the fence (in feet)Does your fence need repairs?*Do you understand that you will be responsible for caring for your foster dog until they are adopted and that can take months?YesNoPlease explainWill you chain the dog in the yard?*YesNoWhy and how often?Would you agree to have your property inspected?*To make sure it's safe for your dog.YesNoHow will you prevent the dog from getting fleas?*What type of identification will your dog wear?*Dog SpecificationsIs this dog a gift?*YesNoWho is the dog a gift for?*Have you (or the recipient) ever owned a dog before?*YesNoWhat happened to the dog?*Still own itDeceasedLostGave awayOtherExplain what happened to the dog*What breed(s) of dog interest you?*Are you familiar with the(se) breed(s)*YesNoWhat age(s) interest(s) you?*you may check more than one Puppy (<1 yr) Young (1-3 yrs) Adult (3 - 8 yrs) Senior (>8 yrs) What size(s) interest(s) you?*you may check more than one Sm (<30lbs) Med (30-65lbs) Lg (65-120lbs) Giant (>120lbs) What coat types are acceptable?*you may check more than one Long Medium Short Regular grooming req'd is OK TrainingHave you ever attended a dog or puppy obedience class or a behavioral class?*YesNoWhen and where*Please list the classes and datesDo you plan to take your dog to an obedience class?*YesNoIf no why not?*Explain why you will not take your dog to classesWho will be responsible for training your new pet?*What techniques and equipment will you use to train your pet?*How do you plan to socialize your dog?*How will you handle behavior problems?*Please describe what you would do if your dog develops any of the following behavior problems: barking, chewing, digging, aggression, inappropriate urination in the houseCostsThere are ongoing costs associated with owning a dog. Are you willing and financially able to provide the following for your dog for its entire life? (Note: costs provided below are average costs. Your actual costs may be higher or lower) $60-$150 FOR INITIAL VET CARE; $50 -$200 for initial obedience training; $25-$100 + per month for food; $150 + for yearly veterinary care and vaccines; $20 + for annual county licensing fees; $500 + for special vet care needs.I understand that my dog will cost on average $800 to over $1,100 or more per year*YesNoIf the dog needs to be returned, the adoption fee may be refunded with the first two weeks, depending on circumstances. Please note that space may not be available with the original foster or an alternate foster and you, as the owner, may need to foster, board or rehome the dog yourself if we cannot find a new home for it. I acknowledge and understand my responsibilities if the dog needs to be returned*Type your full name (this will be considered a legally binding acceptance) and enter dateFull nameDateReferencesMay we contact your veterinarian for a reference?*YesNoPlease explain why we cannot contact your vet*Veterinarian’s name*Veterinarian’s Phone*Acknowledgement of ResponsibilitiesAdopting a dog is a tremendous responsibility. You will be sharing your life with this dog for up to 15 years or more, and during this time the dog will be completely dependent on you for food, shelter, cleanup, and veterinary care. Please initial each of the statements below indicating you accept them. Please answer the questions below and sign this application.I am/We are ready to make a LIFETIME commitment to our new dog*YesNoI/We will give our dog daily companionship, and not just when it’s convenient*YesNoI/We understand that if we return the dog, we will be responsible for its care until a new home is found*YesNoI/We are willing and financially able to care for the dog as described in the Costs section above*YesNoSignature* Typing your name in the box below will considered a legally binding signature. Type full nameEnter DateConfirmation*I/We certify that all information provided in this application is true, and I/we understand that false information may void this application. Once you check the confirmation the submit button will appear. Yes - the information provided is correct EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.