Adoption Application "*" indicates required fields Adoption ApplicationWhich UnderDog are you interested in adopting?* Contact InfoName* First Last Email* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Age*Please list other people in your household: names, age and relationship.* Who is the primary caretaker of the dog?* What types of personalities do you find desirable in a dog?* Is everyone in the household agreeable to a new dog?* Yes No Does anyone in our household have allergies or Asthma?* Yes No If you have visitors, do you have a way to separate your dog from them if it is uncomfortable?* Your HomeDo you have a pool?* Yes No How do you secure your dogs from the pool?Do you live on a canal?* Yes No Do you have a securely fenced yard?* Yes No If yes, what type? Wood or chain link? What height? Does your home have a doggie door?* Yes No If you do not have a yard, how do you plan to exercise the dog? Type of Residence* House-own House-rent Apartment/Condo-own Apartment/Condo-rent Mobile Home Other If you rent, please give your landlord's name and phone number: Do you live in a deed restricted area?* Yes No Your LifestyleOccupation(s)*How many hours a day would the dog be alone?* 0-2 hours 2-4 hours 4-6 hours over 6 hours While you are away, will the dog be kept in a crate?* Yes No Where will the dog be kept while you are at home?* Where specifically will the new dog be kept during the day?* Where will the new dog sleep at night?* Do you feel it is acceptable to let your dog off-leash in an open area?* Yes No Have you ever house-trained a dog before?* Yes No If yes, what method did you use? Are you willing to: Crate-train Adopt a bonded pair Adopt a dog needing house-training Adopt a dog requiring ongoing meds Adopt a dog NOT reliable with children Adopt a dog that is handicapped or blind Adopt a dog that may have been abused Adopt a dog that may/will need professional training Current/Previous PetsCurrent pets name, breed, age: Previous pets name, breed, age: What happened to your previous pets? Do you keep your pets indoors our outdoors?* Indoors Outdoors Do you keep your pets on heartworm preventative?* Yes No Are your pets up-to-date on their vaccines?* Yes No Will your pets accept a new dog into the household? Yes No Please provide your veterinarian's name, specialty vet(s), or shot clinic(s) that you attended.* If applicable, please provide the above mentioned veterinarian(s) phone number(s).*If applicable, please provide your FORMER veterinarian's name. If applicable, please provide your FORMER veterinarian's phone number.Is the pet listed under your name? If not who's name?* Additional Comments200Is there anything else you would like to add or that we should know about you to find you an appropriate match?CAPTCHA
