Are you interested in one of the dogs that we have for adoption? Please complete the application below and we will contact you upon review.



Adopter Information



Your Email (required)


Apartment Number

City, State, Zip

Own or Rent

Phone Number

2nd Phone Number

Do you have any roommates?

 Yes No

Names of Roomates

Landlord/condo board/management company contact information:


Phone Number


Does your lease allow pets?

 Yes No

Are there any breed or size restrictions?

 Yes No

Do you need to pay a pet deposit?

 Yes No

How much is your deposit?

How many children are in your home?

What are the ages of the children in the home?

Do you have previous experience as a dog owner?

 Yes No

Is anyone allergic to dogs in your home?

 Yes No

Is your yard fenced?

 Yes No

Type of fencing:

Height of fencing:

Size of yard:

 Small Medium Large

How long have you been looking for a dog?

Is there an available dog that you are interested in adopting? If yes please provide the dogs name.

If this dog is no longer available, what size, sex, and breeds are you interested in?

Are you interested in a:

 Puppy Young adult (1-3) Adult (4-8) Senior (8+)

Any special needs you have experience with?

How long with the dog be left alone?

Where will the dog be kept when you are gone?

When you are home?

Will there be any restrictions on where the dog is allowed in your home?

Do you have any pets currently?

 Yes No

Name, Breed, Sex, and Age of current pets.

Are all of your pets current on vaccinations?
 Yes No

Last date of vaccinations:

Are all pets spayed/neutered?
 Yes No

Are they on heartworm preventative?
 Yes No

Are they on flea/tick preventative?
 Yes No

Do you have any pets that are no longer with you?
 Yes No

Where are they now?

Veterinarian Name, Address, Phone:

Are you able to spend $500 on average per year for vet care?
 Yes No

Are you able to spend $500-$2000 for a possible vet. emergency?
 Yes No

If you could no longer care for this dog, who will care for them?

What reason(s) would cause you to return this dog to the rescue?

How long will you give the dog to adjust to it’s new home?

Are you willing to go to a dog training class with your new dog?

What would you do if:
• The dog had accidents in the house?
• The dog was chewing things he/she shouldn’t?
• Was barking too much?
• Was jumping on people?

Are you planning to move in the next 12 months?
 Yes No

Will you find housing that allows dogs?
 Yes No

Will you allow us/our representative to do a home visit prior to adoption?
 Yes No

Please list 3 references that know your ability to care for a dog. Only one can be a family member please. Please include, name, phone and how long you have known them.