Do you have other pets at home?
Yes
No
If yes, please describe breed, age, and sex:
Where are these pets now?
Would you consider fostering a dog or puppy?
Yes
No
Reason for new pet request?
Inside or outside animal ?
Inside
Outside
Where will this animal sleep?
What kind of protection from weather?
Do you have children at home?
Yes
No
If yes, how many and how old?:
We require a Veterinary reference, if you do not currently use a Vet, please
provide two personal references of people who have animals, use a Vet and are not your relatives:
Vet Clinic Name
Vet Clinic Phone #
Financially able to provide pet care and medical?
Yes
No
Do you or members of your household have any pet allergies?
Yes
No
If yes, please describe:
Residence type:
Apartment - owned
Apartment - rented
Single family house - owned
Single family house - rented
Mobile home - rented
Mobile Home - owned
Condo - owned
Condo - rented
Multi-family home - rented
Multi-family home - owned
If other, please describe:
If renting, please provide a landlord reference:
Do you have a fenced yard?
Yes
No
What type of fence?
Split-Rail
Picket <4 ft
Picket >4 ft
Privacy Fence
Other Describe:
What type of exercise are you able to provide for pet:
Have you ever been convicted of a crime?
Yes
No
What kind of arrangements do you plan for your pets when you take trips:
Hours a day pet will be Hours per day animal will be alone?
none
1-3
3-6
6-8
8-10
over 10 hours Why have you chosen to adopt from a rescue?
Any comments or questions?
