Enrollment Information

Application Information

First Name: Last Name:

Street Address:

City: State: Zip Code:

Home Phone number: Cell Phone number: Email Address:

Number of residents in home: Ages of residents:

Number and type of other pets in the home:

Do you live in a: House Townhouse Duplex Apartment

Do you have a fence? What kind of fence and height?:

Have you owned or cared for a dog before? Yes No

What breed?:

Have you ever given up a dog before? Yes No

If yes, What were the circumstances?

Have you ever potty trained a dog? Yes No

If yes, how did you potty trained the dog?

Have you ever crate trained a dog? Yes No

Do you use monthly preventative care (heartworm and flea and tick control)? Yes No

How often and how will the dog get exercise?

Where will the dog sleep?

Will the dog be allowed on the furniture? Yes No

What dog food do you use to feed your dogs?

What training will you provide for your dog?

How will you deal with any behavioral issues that the dog may exhibit?

Where will the dog stay when you are not home during the day?

May we contact your vet? Yes No

Vet name and phone number:

If you are interested in a certain dog, please identify:

What type of agreement are you interested in?

Adoption: I will pay an adoption fee and the dog will belong to my family. No continued care is provided.
Additional Assistance: I would like to discuss additional assisance that would be available to me.

It is our mission to carefully match up the right dog with the right home and provide continued care if needed.

We will do a home visit to confirm the applicant's ability to care for the dog and verify that the environment is safe for the dog.

This enrollment information will be emailed to us and we will contact you and make arrangements for a home visit.