| Full
Name |
|
| Address |
|
| City,
State, Zip |
|
| Home
phone number |
|
| Alt
phone number |
|
| Email
address |
|
| Home
situation? Rent or Own |
|
| House,
mobile home, or apt.? |
|
| If
renting, name/number of landlord |
|
| Fenced
yard? |
|
| Describe
the type of fencing |
|
Number
of all adults and
their ages in the household |
|
Number
of all children and
their ages in the household |
|
Are
all family members in
agreement for adoption?
|
|
How
often are there visitors
to the home?
|
|
Other
pets living in the home
|
|
Current
on vaccines?
|
|
Describe
living arrangements for pets
|
|
Have
you ever given up a pet?
|
|
If
so, please explain the circumstances
|
|
How
many hours a day will
this pet be alone? |
|
What
accommodations are
in place for alone time? |
|
| Where
will this dog stay at night? |
|
How
often do you plan to
exercise this dog? |
|
Does
your commitment to your new
pet include working through issues
(ie: fear of strangers, chewing, fear,
separation anxiety, walking on leash,
jumping a fence)? |
|
Describe
the pet that suits your
lifestyle i.e high energy |
|
| Veterinarian
name and number. |
|
| Personal
Reference #1 |
|
| Personal
Reference #2 |
|
Which
pet are you interested in?
|
|
Would
you like a recommendation
of a pet?
|
|
Would
you be interested in
becoming a foster parent?
|
|
| Any
comments |
|
| |
|
| |
