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This application is for a Cat Dog Name of dog/cat (s) you are interested in: Applicant Information Full Name:  Age: Name of Spouse/Partner: Roommate(s): Street: City:  State:  Zip: Home Phone: Work Phone: Cellular: Email: Occupation: Spouse/Partner Occupation: Work Schedule: Spouse/Partner Work Schedule: Names of all persons living in your household, their relationship to you and their ages: Does EVERYONE in your family want to adopt?: Yes No Please list a personal reference and their relationship to you: Name: Relationship:  Phone: Home Type of dwelling? Home Apt       Own Rent Millitary If you live in a condo or apartment what are the association's rules about pets? Your home has: 1 story 2 stories Pool If adopting a dog, do you have a pool? Yes No If you have a pool, is it fenced? Yes No How do you introduce a dog to a pool? I don't know. Would you object to an inspection of your home by a rescue volunteer? Yes No If not a home owner, do you have the landlord's permission to have a pet? Yes No Landlord's Name:  Phone: Your Companion Animals Do you have the financial means to spend hundreds or even a few thousands of dollars on veterinary care for your pet should the need arise? Yes No Do you presently have a dog? Yes No Have you previously had a dog? Yes No Current Dog(s) Name & Breed:  Age: How long have you have the dog?  Sex Altered: Yes No How & Why Obtained: Additional: Previous Dog(s) (1) Breed:  Age:  Sex Altered: Yes No History: Select One Gave Away Sold Lost Took to Pound Died (Please inlude details.) Other (Please inlude details.) Details: (2) Breed:  Age:  Sex Altered: Yes No History: Select One Gave Away Sold Lost Took to Pound Died (Please inlude details.) Other (Please inlude details.) Details: Additional: Have any of your dogs/cats ever had puppies/kittens? Yes No If yes, you bred for (Check all that apply.): Fun Profit Show Accident Has any member of your family ever experienced animal-related allergies? Yes No Have you ever trained a dog in obedience classes? Yes No Other Pets If you have other pets:   How many? Species: Where Kept? How long have you had pet(s): If cat, de-clawed? Yes No Veterinarian Name:   Phone: Your New Dog/Cat Who would be responsible for pet's care? That is your primary reason for adopting? Where will your pet sleep? Indoors Outdoors    Where: Hours per day pet will be left alone? Where would the pet be left when he/she is alone or when you are away from your home? Indoors Outdoors       If outdoors: Yard Patio Kennel Garage        Doggy Door? Yes No     Other If yard fenced: foot high.     What kind of fence? Wood Chain   Other Have/Would you use a pet-sitter or pet daycare center? Yes No When home, pet will be: always / mostly – indoors, always / mostly – outdoors If pet will be outside at all, what outside space is available? Garage Dog Run Fenced Yard Unfenced Yard Patio Balcony Other How do you plan to handle pet’s exercise needs? Do you travel a great deal? Yes No How often?   How long at a time? When you do travel, how do you intend to provide for the pet while you are gone? If a pet became destructive to your home, what would you do? Do you have any “musts” for a pet? If yes, please elaborate: What provisions would be made if you had to move? Locally?   Out of state? To a place where no pets are allowed? If adopting a dog: Do you feel obedience training makes a dog a better companion? Yes No If necessary, are you willing to attend obedience classes at your expense? Yes No Under what circumstances would you not keep the dog? (Check all the apply.) Divorce Family Illness Moving New baby Dog grew too big New job Chewing Kids ignore Digging Biting Pets don't get along Barking Shedding Medical bills Allergy Not obedient Housetraining problem   Other Explain What would you do if the dog grew to be bigger than you expected? Return to the rescue. Take to the shelter. Keep outside. Explain A dog may live 15+ years. What would you do with your dog if you could no longer care for it? Additional Information & Signature Is there anything else you would like to tell us about yourself or your home environment? All of the information I have provided in this application is true and correct. If any of the information changes, I will advise you promptly. Digital Signature:     To sign with you digital signature, please enter your birth month in the box above. (e.g. September)