Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is everyone in the household in agreement of adopting a dog? *

Yes

No

Are you willing to have a representative of K-9 visit where the dog will be living? *

Yes

No

Do you have a fenced-in backyard? *

Yes

No

Can you provide proof that you are allowed to have a dog (lease or HOA)? *

Yes

No

If renting, is your landlord aware you are applying to adopt a dog *

Yes

No

N/A

Is any member of the household allergic to dogs? *

Yes

No

Are there times when the dog will be left outside unsupervised? *

Yes

No

Do you currently have a dog(s)? *

Yes

No

Do you currently have a cat(s)? *

Yes

No

Spayed/Neutered *

Yes

No

Current on vaccines

Yes

No

Have you ever had to find a new home for your pet?

Yes

No

Have you ever turned a pet into a shelter?

Yes

No

Do you have plans for a mid-day break?

Yes

No

Do you plan to attend obedience training?

Yes

No

Are you willing to train any unwanted behaviors?

Yes

No