Pets’s name you wish to apply for:

Applicant’s name:

Address:

City, State and Zip Code:

Home phone number:

Cell phone number:

Home email address:

Place of employment:

Your position:

How many hours per day will the dog be alone?

Do you own or rent your home?

If renting, please give landlord’s name and phone number:

Please list the names and ages of all persons living in your household:

Will you crate your new pet?

List all animals living in your household with breed, age, and indoor/outdoor pet:

Are your pets spayed and neutered?

Your last pet if you do not currently own a pet?

What was the reason for your last visit to your vet?

Please provide a number for your veterinarian:

Please provide the names and phone numbers of two people that know your pet ownership history:

Have you ever adopted a rescue pet from a shelter or humane society?

How do you cope with behaviour problems in your pets?

Would you or have you ever surrendered a pet?

If you are approved, when and how will you pick up your pet?

I certify that the information I have given is true and I understand that any misrepresentation of facts may result in losing the privilege of adopting a pet or in the immediate reclamation of an adopted pet. I understand that this application may be denied. I authorize investigation of all statements in this application.

IF YOU ARE APPROVED TO ADOPT. YOU WILL BE REQUIRED TO SIGN A LEGALLY BINDING CONTRACT.

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