Your Name
Home Phone:
Cell Phone:
Cell Work Phone:
Email:
Alternate Email:
Adult#1 Name and Relationship
Adult #2 Name and Relationship
Child #1 Name and Age
Child #2 Name and Age
List anyone else living in the home, their ages, and relationship
What is your vet’s name?
Your veterinarian’s phone number:
Breed
Gender and Spayed/Neutered?
What is his/her primary living and sleeping areas?
Pet #2 Name and Age
Pet #3 Name and Age
List any other pets that live with you.
What has happened to any previous pets that you have had?
Additional Comments?
What type of home do you live in (single family, condo, town home, apartment)?
Do you own or rent your home?
If you rent, have you received the approval of your landlord to adopt an animal?
Is your yard fenced?
Type of Fence (privacy, chain link, invisible)
How high is your fence?
Tell us about any training experience you have.
How long will your dog be alone during the day?
Where will your dog spend most of his/her time (inside; inside/outside; outside)?
Gender/Age preference
What energy level best fits your lifestyle (very active, normal active, low activity)?
What type of activities will you do with your dog?
Have you ever had to relinquish or re-home a pet in the past? If so, what were the circumstances?
List any reasons why you would relinquish or re-home your dog?
Additional comments
