Enrollment Information

Enrollment Information

First Name: Last Name:

Street Address:

City: State: Zip Code:

Phone number: Email Address:

Number of residents in home: Ages of residents:

Do you live in a: House Townhouse Apartment Duplex

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

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

What breed of dog are you interested in:

Which one of our plans are you interested in?

A

Adoption: Our adoption fee is $200 and the dog will belong to your family. No continued care is provided.
B

Basic Care: Our basic care will include routine veterinary care and grooming services. We will pick up the dog and take them to the vet or groomer and return them to you. Your cost will be $240 a year or $20 a month recurring donation.
C

Complete Care: Our complete care will include routine veterinary care and grooming services as well as a monthly delivery of dog food and heartworm preventative. We will also watch your dog if you are on vacation or in the hospital or nursing home. Your cost will be $360 a year or $30 a month.

NOTE: If are unable to pay and we have funds available from grants and gifts, we will provide assistance for you.

This enrollment information will be emailed to us and we will contact you and make arrangements for a home visit. Once you are an approved home, we will find the perfect senior dog to live with you in your home.