Application

Date you will be ready for your new dog *

Address (Street Address, City, State, and Zip Code) *

Please list the people living in your home and their ages *

Is everyone in agreement on adopting a new dog? If not, please explain below. *

Do You Rent Or Own Your Home? *

Rent Own

If you rent, please provide your landlord's name and phone number. *

Are pet's permitted? *

Yes No

How long have you resided at your present address? *

Do you have a yard? *

No Yes ~ Fenced In Yes ~ Not Fenced In

How will your dog be exercised? *

How long will your dog be left alone? *

Where will your dog be kept when left alone? *

Training *

I will be crate training my new dog. I have crate trained a dog in the past. I have taken a dog to obedience training in the past. I will take my new dog to obedience training. I understand that my dog may develop issues as it adjusts to my new home. I will tolerate barking. I will tolerate chewing. I will tolerate housebreaking accidents.

If your new dog develops issues that do not get resolved in a reasonable amount of time, what will you do? *

What do you consider a reasonable amount of time for your new dog to adjust? *

How long have you been searching for a new dog? *

Why did you choose this dog? *

Household Information: (please check all that apply if the answer is yes). *

Is there anyone in your home that is allergic to animals? Is there anyone in your home that is fearful of animals? Do you have pets now? I do not have any other pets in my home right now.

Pet History - Please list your current animals. Include breed, age, and sex. *

Are they spayed or neutered? *

Yes No I do not have any other pets.

If your pet is not spayed or neutered, please explain why. *

Have your animals been around other dogs? *

Yes No Not Applicable

How did your animals react around other dogs? *

List any animals you have had in the past. Please include name, breed and sex: *

Reason for no longer owning the pets: *

Have any of your pets ever been lost or hit by a car? *

Yes No Not Applicable

If you answered yes, please explain. *

Veterinarian Information (Name, address and phone number): *

Reference #1 (Name, address, phone number, email address, relationship): *

Reference #2 (Name, address, phone number, email address, relationship): *

Please review the adoption contract after you have submitted your application.

adoption_contract.pdf
File Size:	149 kb
File Type:	pdf

Download File

If you prefer to complete a hard copy of the application, please download the file and email to [email protected].

shelter_survivors_application.pdf
File Size:	148 kb
File Type:	pdf

Download File