Name

Date of Birth

Age

Phone number

Email

Address

Number of adults in the household

Number of children in the household

Ages of children

Does anyone in your household have allergies to dogs?

Is everyone in the household aware of and agree to adopting a dog?

Home Ownership

• Own

• Rent

Landlord Name (if renting)

Phone number

Does your landlord allow dogs?

Do you have a fenced yard?

If yes, please describe the type and height of the fence:

Do you have pets?

Are your pets spayed/neutered?

Are your pets vaccinated?

Preferred Breed

Age

• Puppy

• Young Adult

• Adult

Coat Type

• Short

• Medium

• Long

Why do you want to adopt a rescue dog?

Have you ever owned a dog before?

If yes, please describe your experience:

Have you adopted from a shelter before?

Have you given up a pet before?

If yes, specify the reason:

How do you plan to handle training and discipline?

How many hours per day will the dog be alone?

Where will the dog stay when you are not at home?

Who will be primarily responsible for the dog's care?