Dog Application - Online Form Submission Which dog would you like to adopt? Name Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zipcode Phone Number E-mail Why do you want to adopt/rescue a dog?
If renting, does your lease allow pets?
Landlord's Name Landlord's Phone Number
Do you live with someone/have a roommate?
If yes, please provide Roommate Name(s) and Phone Number(s):
Do you have kids, or are there any children who will have frequent contact with your adopted animal?
If yes, please list ages of the children (to include ages of any grandkids who may be around your dog):
Does anyone in your household have any allergies to animals?
What is the noise/activity level of your home?
Do you plan to use any of the following?
Do you have a fenced in yard?
If yes, what is the fence height and style? How many hours a day will the dog be left alone?
When alone, where will your dog stay?
When you are home, where will the dog be allowed?
Where will the dog sleep?
Is this your first experience with a dog?
Do you currently have other pets?
If yes, please list type, age, and breed/size of other animals that live in your home:
Are all other animals in your home spayed/neutered and up to date on shots?
Do you currently have or have you recently had a veterinarian?
Veterinarian's Name Veterinarian's Phone Number: How long are you willing to give your dog to adjust to your home?
Do you have any health conditions that could restrict your ability to care for the animal?
What will you do with your dog in the event that you are unable to care for your dog or move?
Have you ever surrendered an animal to a shelter or rescue?
If yes, what were the circumstances? If necessary, what methods will you use to housebreak your dog?
Have you ever experienced behavior or training problems with your current or previous dogs?
If yes, please explain how you resolved these problems:
Would you be willing to have an in home visit by a DNA representative?
Please provide two personal references who can speak to your character and any past experience with dogs: Submit