Full Name & Age: *


Your Email: *


Full Mailing Address: *


Phone: *


How many hours will your new pet be left home alone everyday? *


What form of discipline and/or training will you be using? *


What reason(s) would make you give up a pet? *


Do you live in house/ apartment? *


Years at address? *


Own/Rent (landlord name and phone #) *


Please describe your yard, {Is there a yard? Is it fenced? What type of fence, height?} *


Where will the dog be kept during the day/night? *


Where will the dog sleep? *


How many people live in the house? Ages? *


Tell us about your pets you currently own. : {Please include names, breeds, ages, and whether your pets are spayed or neutered. Vet’s name, phone # etc.} *


Next, please tell us about other pets you have previously owned. For each pet, please include the following information: breed, age, length of ownership, how ownership ended. If the animal passed away, please include the cause of passing. If the animal was “re-homed”, please provide details. Tell us about any pets you have previously owned. *


What breed/type of dog are you looking for? (If you don’t know what breed)-what size of dog are you looking for? *


What age of dog? Male or Female, Puppy, young (under 2), older (2+): *


Are you willing to adopt a blind, deaf or other special needs dog? *


Who will be responsible for medical treatment? *


Who will be the primary caretaker of the dog? *


Does anyone in your household have allergies or asthma? *


Does the county or city where you live have any Breed Specific Legislation? *


Are you interested in cropping the dog’s ears or docking its tail? *


How far are you willing to travel to meet a pet? {For example 1-2 hours, 3 hours or any distance} *


Please tell us what the dog’s purpose in your life will be? *


Where did you first learn of this website? *


Comments or Questions?