Please fill the application out in FULLIncomplete applications will be deleted.

To move between questions you MUST use the TAB  key or the MOUSE.   

The enter key will automatically act as the send button and you'll end up sending an incomplete applicaton. 

Today's Date
First Name
Last Name
Address
City
State
Zip
Work Phone
Home Phone or Cell REQUIRED
Cell Phone
Email Required

If more than one adult in the home, please give their name too (First and Last):


Are you interested in a specific dog? YesNo
If 'yes' which one?
Would you consider a Mix?  YesNoMaybePrefer Mix
Do you have a gender preference?
Do you have a color preference? YesNo
If yes what color?
Are you looking for indoor or outdoor dog?
What Age Range are you looking for? 
Please list the characteristics you'd like in your new pet: (check all that apply)
Good with children
Good with other pets
Playful
Dominant
Loving
Independent
Shy
Protective
Active
Feel free to list Other Characteristics
Please list what roles in the home you'd like your new pet to fill (check all that apply)
Companion Family Pet
Protection
Therapy
Obedience Trials
Hunting
List any Other roles you would want your dog to fill in your home:

We recommend to facilitate the bonding process each new dog should attend an obedience class.
Would an obedience class in your area be something that you would be willing to do? YesNo 
If you checked "No" please explain why not:


Residence: 
If you rent please give the Owner's Name & Phone number below
Owner's Name
Owner's Phone

Where will your dog stay when you are NOT home?
How many hours will your dogs be home alone?
Do you have a crate? YesNo
Describe your feelings about crating?
Describe where your dog will stay when you ARE  home?
Where will your dog sleep at night?
Do you have a fenced in yard YesNo
Type of fence
Fence Height
If No fence how will you potty and exercise your dog?
How many Adults live in the home
 
How many Children in your home
(please include weekend visitations)
Please list the ages and genders of the children
 Are you expecting a Child? YesNo
 Does anyone in the home have allergies to pets? YesNo
 

Do you currently have any dogsYesNo 

Please list ALL of the Dogs currently in the home: Name,  Age, Breed and Gender
Do you currently have any catsYesNo
Please list ALL of the Cats currently in the home: Name,  Age and Gender
Please list any Other Pets in the home, (Birds, rabbits, snakes, etc.)
Are ALL of your Dogs & Cats spayed and neuteredYesNo
If one or all are not spayed or neutered please tell us which are not and why not for example; planning to breed, too young, etc.
Have you had any other dogs? Please give us their name and tell us what happened to them.
Are your dogs current on Heartworm PreventiveYesNo
If Not on Heartworm Preventive please tell us why not
 Are all of your pets current on their vaccinations YesNo
If they are Not Current on their  Vaccinations please tell us why not
Current Vet Name

Many Vets require your authorization to release information. We do call your veterinarian to verify records. Please contact your Vet giving your permission for us to discuss shot records. If we call your vet and permission has not been granted, we will stop there and delete your application.

Current Vet Address
Current Vet Phone
If you have been with your "Current" Vet for less than 1 year or the "Current" Vet has not seen your pet for shots yet, please fill in the name of your previous vet. 
Previous Vet Name
If you had a pet, please give the name and phone number of your previous pet's Vet.
Previous Vet Phone

Your Occupation
Employers Name
Employers Address
Spouse Occupation
Spouse Employers Name
Spouse Employers Phone

 

Please list the name, address and phone number (with area code) of a personal reference

 

Please list the name, address and phone number (with area code) of a second personal reference

 

Please list the name, address and phone number (with area code) of a third personal reference

 

Are you willing to sign an Adoption Contract YesNo
Comments? 
Or more that you'd like us to know about your family? 
Feel free to write them here:

Have you missed any of the questions?  

If the application is not filled out in full, it will be deleted.


By clicking the 'submit' button I certify that the above information is true. I further certify that I am financially and physically able to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to meet these obligations. I understand that a home visit will be made prior to adoption.
If any information contained in this application is found to be false, your application will automatically be rejected.
Please only hit the SUBMIT button Once (it takes a little while to think)