First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Date of Birth of Applicant?*

Are you employed? If yes, please provide employer's name, address, your position and length of employment. If not employed, please list any source of income (spouse's income, disability, retirement fund, etc.) or unemployed. *

How many people reside in your household*

Please list the name and ages of others in your house hold (If no one please list none)*

Who in the household will care for the pet*

What is the best way to contact you?*
Choose one: e-mail phone - after 6 pm mail no preference phone (anytime)

Which animal are you interested in
Choose an animal: Annabelle Apollo Beau Bennie Camie Chipper Ciara Dolly Jasmine Kiddo Levi Liam Liberty Libra Logan Lonnie Lyra Maggie Mona Ollie Pasco Paulie Peanut Posey Rudolph Sailor Schotzie Selena Seymour Tabi Tiffany Tootsie Travis Wayne

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home? If you rent, how long have you lived at this residence?*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal*
Choose one: No Yes Does Not Apply

If you rent, please enter your landlord's name and phone number. If this does not apply, please enter N/A.*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day*

Where will the animal be kept when you are home*

Where will the animal sleep*

Where will the animal be kept when you are not home*

Have you ever given up a pet? If yes, please explain*

Do you currently have any other pets?

If yes, please check all that apply:

Do you agree to use Heartworm Preventative?

What traits are you looking for in a pet

Please describe any and all characteristics that you are seeking in a new pet (breed mix, age, personality, size, activity level). The more you tell us about what you're seeking in a new pet, the better we can match the right pet to your home: *

Why are you interested in adopting a pet at this time

WE CANNOT PROCESS YOUR APPLICATION WITHOUT ALL of the following information: veterinarian's name and phone number (Please call your vet to give them permission to speak with us. Failure to do this will result in a delay of application processing.) NAME OF PET SEEN BY THIS VET *

List at least one reference (who is not a family member and does not live in the household) and their phone number*

How did you hear about us?

Is there anything else you would like us to know?