Name of Animal You are Interested In
Your Name (First and Last)*
Email*
Phone Number*
Address*
Where do you live?
House Apartment Condo Duplex Other:
Do you rent or own?
Rent Own
If you rent, please provide contact information of landlord
Do you smoke inside your home?
Daily Weekly Rarely Never
Is your yard fenced? If no, please specify how you will contain your animal outside.
Yes No
Will your animal be left outside unattended?
Yes No, except to go to the bathroom Other
Are there children in your family? If so, please list ages.*
Do you have any other pets? If so, please list breed, age, and if they are UTD on shots and neutered/spayed.*
Have you owned any pets in the past 5 years that are no longer in your possession? If so, please explain why they are no longer with your family.
Where will the animal sleep at night?*
How many hours on average will the animal be left alone each day?
Will this animal live...
Indoors Only (except when outside to play/potty) Predominantly outdoors Combination
If you selected "Combination" above, please explain.
How often do you plan on walking this animal?
Multiple times per day Once per day 3-5 times/week Rarely
What are you looking for in an animal? * Check all that apply
Independence Dependence Lap dog Exercise partner Watch dog Kid friendly Energetic Lazy Playful Serious Sidekick Other:
Which characteristics would you not tolerate in an animal? * Check all that apply
Not housebroken right away Dog aggressive Cat aggressive Too hyper Digger Fence jumper Barker Drooler Protective over food/toys Not housebroken after training Other:
If your animal displayed one of these traits, what would you do?
Consult a behaviorist Consult a vet Work through it Surrender back to rescue Other:
What is the best way to correct your animal's mistakes? *
Swat on the butt Yell 'No!' Redirect the behavior Ignore, but praise when he/she does something good Kennel him/her when he/she is bad Other:
If you are applying for a pit bull or pit bull mix, please describe your experience with this breed.
Please list 2 references with email addresses or phone numbers if no email access (not family members). * Email preferred.
If you currently have animals or recently had an animal, please list your vet's name and number and email address if possible. If you do not have a vet, please list the vet you plan to use.*
Is there any other information you would like to provide us with?
Under what circumstances would you return an animal to the rescue? *
Moving across state/into an apartment, etc. Lost job/can no longer afford Behavioral issues (i.e. dog aggression, etc.) Health issues (i.e. hip dysplesia) Having kids Gets too big, etc. Under no circumstance Other:
I certify that the above information is true and accurate.
How did you hear about us? *
Petfinder Craigslist Word of mouth Internet Search Adoption Day Other:
