Date
Name of Dog Desired *
Name: *
Age
Address
City
State
Zip Code
Email Address *
Home Phone
Cell Phone
Work Phone
Marital Status
How did you hear about us?
Do You Live in a Condo Townhouse House
How long have you lived at this address?
Do You Rent Own
Name and Phone Numer of Landlord
Landlord Approval Yes No
Pet Restrictions (i.e: Weight limit, Breed, Type of pet)
Name of Home Owners Association
Association Contact Number
Restrictions
How Many Adults Reside in the household?
Are there children living in your home?
Have you ever turned an animal in to an animal shelter? Yes No
If yes, please explain
Would your new pet be living outdoors or indoors? Outdoor Indoor
Where will your new pet sleep?
Where will your new pet be when no one is home?
Indoors
Outdoors
Where will your new pet be while you are at home?
Do you have a yard? Is it fenced? If so, what type of fence?
Does everyone in the home want a new pet?
Where will the new pet stay when you go on vacation?
Who is your veterinarian?
Veterinarian phone number
How many pets are currently in your home?
Breed/Sex of dogs:
Are they spayed/neutered?
Do your dogs live Outdoors or Indoor?
Please provide three reliable references
Name
Relationship
Phone Number
Years they have known you
I swear that all information is true and accurate and I will provide proof when asked
Your Name
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