* Denotes required field |
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First Name *: |
Last Name *:
Occupation:
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Your Age: |
Email *:
Phone:
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Partner First Name: |
Partner Last Name:
Partner Age:
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Address 1: |
Address 2:
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City: |
State:
Zip Code:
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How many hours do you work outside the home on a daily basis: |
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HOUSING INFORMATION |
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Own or Rent: |
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If renting - Landlord: |
Landlord Phone:
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Do you have a fenced yard? |
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HOUSEHOLD INFORMATION |
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Ages of children living in house: |
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How many hours will your dog be home alone daily? |
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ANIMALS IN YOUR HOME |
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Currently, how many dogs in the home? |
Are they spayed or neutered?
If you currently own cats, how many?
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If you currently have dogs in your home, what type of monthly prevention do you use? |
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Please list name, breed, gender and size of your current dogs: |
Where do/will your dog(s) sleep?
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Have you previously owned pet(s)? |
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If so,
please describe your pet(s) and the reason they are no longer with
you: |
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VETERINARY INFORMATION |
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Please provide name and number of your Veterinarian: |
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REFERENCES AND PREFERENCES |
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Please provide a personal reference: |
Personal reference phone:
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If you are interested in a specific adoptable dog, what is the dog's name? |
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Any adoption preferences (size, breed, age, etc.): |
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Additional comments (50 word max.): |
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