First Name Last Name Street Address City State Zip Cell Phone Home Phone Email If there are other dogs that interest you, please list them here: Have you applied in the past? If so, when? Facebook name: Current Veterinary Name Phone number Past Veterinary Name Phone number Name on Veterinary Account Vet services done at a clinic? Provide phone number Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Breed Sex Spayed/Neutered Time owned Current health/Death Age Name Phone Number Relationship Name Phone Number Relationship Name Phone Number Relationship Name Phone Care Provided If renting, please provide landlord's name Phone number Breed Size How long have you been at current address? If yes, when? Adults: Children: If yes, who Occupation of head of household and partner? What hours are you typically away from home? If yes, who? Describe a typical day for your pet. How long will your pet be home alone? Consider hours of work and commute time. Where will your pet stay when you are not home? Why are you interested in adopting a pet and what do you think it will bring to your family? What behaviors/characteristics/traits do you NOT want in a pet and feel cannot be worked through? Under what circumstances would your pet need to be rehomed. If you have ever had a pet for a short period of time explain. What is your plan for house training? Share your opinion of crate training. Where will your pet sleep at night? What will you do with your pet when you go on vacation? Age Range Size (full grown) Activity Level Have you done any breed specific research, online or print? If no, explain If no, explain If no, explain Please add any information, facts. or comments which might aid us in picking the right pet for you.