Adoption Application Name or Type of dog that you're interested in adopting*Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Main Phone #Alternate Phone #Occupation*Spouse/Partner OccupationYour Age*How many adults live in your home?*Who will be the primary caregiver?*How many children live in your home?*What are their ages?Do you or anyone else in your household have pet allergies?*YesNoVeterinarian's name and number:*Do we have permission to check past vet records?Your HomeWhich do you live in?*HouseApartmentTownhouseCondoMobile homeDo you own or rent?*OwnRentIf you rent, do you have your landlord's permission to own a dog?YesNoIf yes, we would also want to contact the owner to get confirmation.Are there any breed or weight restrictions?YesNoPlease explain the breed or weight restrictions at your rental propertyDo you have a yard?*YesNoIs the yard totally enclosed?YesNoWhat is the lowest height of your fence?Is the fence/gate kept locked?YesNoHave you recently checked the entire perimeter of the fence to ensure that a dog cannot escape?YesNoLOOK FOR SOFT DIRT TO DIG UNDER, BARS SPACED TOO FAR APART, etcDo you have a pool?*YesNoIs the pool fenced?YesNoDo you have a doggie door?*YesNoCan you ensure that your gardener, housekeeper, etc will not let the dog out of the yard?*YesNoFuture Dog and Pet HistoryDo you have any other pets?*YesNoPlease list their breed and ageDo they live inside or outside?InsideOutsideAre they up to date on their vaccinations?YesNoAre your pets neutered/spayed?YesNoAre they dog socialized?Have you ever introduced a new dog into your home? If yes, how did it go?Do you walk your dogs? If yes, then where?If you were to see a Coyote on your walk what would you do?*Which of the following are true?* Coyotes come out during the day Coyotes can jump over an 8ft. fence Coyotes will attack dogs even on leashes Coyotes are not afraid of humans All of the above Check all that applyIf you drive a pick-up truck, would you allow your dog to ride in the back?*YesNoHave you ever owned a pet before that you no longer have?*YesNoPlease list them all and explain what happened to each one*Eg. Passed away, given away to family, taken to a shelter, ran away, etc.Was your last dog obedience trained?YesNoHave you ever turned your pet into a shelter?*YesNoIf yes, please explain.Please enter a value between 0 and 24.Why do you want to adopt this dog?* Companion for you Companion for children Playmate for other pets Guard dog/protection Therapy dog Gift Other (please explain) Check all that applyHow many hours will the dog be left alone on a typical weekday?*Please enter a value between 0 and 24.Where will the dog be kept during the day?* Indoors (loose) Indoors (in one room) Laundry room Crated Balcony Tied up Yard Enclosed patio Dog-run Garage Check all that applyWill any place be off-limits for the dog when you are home? (i.e.- furniture, bedrooms, etc)*Would this dog be left alone in the yard at any time? If yes, please explain.*Where will the dog sleep at night? (please be specific - eg. garage, kitchen, etc)*Brand and Type of food you will feed the dog?*Which pet store will you purchase the food from?What type of flea control will you use?How will you care for your dog's teeth?*How much are you willing to spend on medical bills for your dog?* up to $100 up to $500 up to $1000 up to $5000 whatever it takes Check all that applyIf you did not answer "whatever it takes" - what would you do if the vet bills go over the amount you chose?Under what circumstances would you consider giving up this dog?* Destructive chewing Barking Not housebroken Biting Too shy Shedding Separation anxiety Medical problems Not obedient enough Grows too big Too hyper Pets don’t get along Working too many hours Moving New baby Divorce Allergies Financial problems Personal health problems None of the above (I would not give up this dog) Check all that applyIf you move will you take the dog with you? If no, please explain.*What will you do if you move somewhere where dogs are not welcome?*For what reason would you euthanize a dog?*Do you think it's necessary for your dog to wear an ID tag?*What provisions will you make for the dog if you should become unable to care for it?*Who will take care of the dog when you travel?*What methods will you use to train this dog?* Praise Verbal commands Clicker training Hit with newspaper Spanking Shock collar Hire a trainer Group classes Check all that applyWhat method will you use to potty train?*When would the dog be off-leash outdoors?*Will you use a choke chain? If yes, then when and why?*May we conduct a home check prior to finalizing the adoption?*YesNoAre you ABSOLUTELY SURE that you are ready to make this LONG TERM COMMITMENT?*YesNoHow did you hear about us?PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.