| *Name: |
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| *Email address: |
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| *Address: |
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| *City: |
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| *Province: |
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| *Home phone: |
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| Work phone: |
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| *Age: |
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| *Who will be the primary care giver for this pet: |
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| What gender pet do you prefer: |
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| *Is there a breed you prefer and why: |
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| *Why are you interested in owning a rescue dog: |
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| *Why do you want a pet (eg companionship, protection, working dog): |
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| *What qualities would you consider most important in choosing your new pet: |
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| What traits would you consider unacceptable in a new pet: |
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| *How often will this pet be without human companionship on a daily basis: |
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| *Where will this pet be kept during the day: |
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| *Where will this pet be kept during the night: |
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| *What type of dwelling do you live in: |
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*Do you own or rent your dwelling: |
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--------------------------------------------RENTERS please provide the following information:-------------------------------------------- |
| Landlord’s name: |
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| Landlord’s phone number: |
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| Does your landlord allow pets: |
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| Amount of deposit required: |
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| Amount of monthly rental increase: |
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| *If you were required to move in the future what would you do with your pet: |
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| *Do you have a fenced yard: |
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| If yes, please describe height, material etc: |
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| *Number of adults in your household: |
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| *Number of children in your household: |
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*Ages of household members: |
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| *Please describe the dog experience the members of your household have: |
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| *Is anyone in your family allergic to animals, please describe |
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| *Would you be willing to allow a representative from our organization to visit your home before or after the adoption: |
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| Please list the pets you own or have you owned in the past 10 years: |
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| Name: |
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Age: |
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| Gender: |
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Breed: |
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| Spayed/Neutered: |
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Pet still with you: |
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If this pet is no longer with you, please describe why not (ie, passed away, surrendered etc) |
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Where was this pet kept during the day and night:
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| Name: |
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Age: |
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| Gender: |
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Breed: |
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| Spayed/Neutered: |
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Pet still with you: |
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If this pet is no longer with you, please describe why not (ie, passed away, surrendered etc) |
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Where was this pet kept during the day and night:
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| Name: |
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Age: |
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| Gender: |
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Breed: |
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| Spayed/Neutered: |
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Pet still with you: |
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If this pet is no longer with you, please describe why not (ie, passed away, surrendered etc) |
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Where was this pet kept during the day and night:
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(please add additional pets to the “Additional Information” section of the application) |
| Name of vet for above animals: |
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| Phone number of vet for above animals: |
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| If you currently own other pets are they up to date with their vaccinations: |
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| If you currently own other dogs are they on heartworm prevention: |
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| *What is the name of the vet you intend to use: |
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*What is the number for the vet you intend to use:
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| *What is the potential life span of the animal you are considering adopting: |
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| *Are you prepared to allow a significant adjustment period for your new pet, particularly if there is another animal in your home: |
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| What will you do if your new pet doesn’t get along with your current pets: |
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*Are you willing to invest in training and take responsibility for your dog’s behavior:
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| *How do you plan to housetrain your dog if necessary: |
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| *What type of exercise do you plan for your new pet: |
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Is there any additional information you would like to share with us? |
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