Most fields are required.

Personal Information

Name

Date of Birth

Address

City

Zip Code

Daytime Phone

Evening Phone

Email

Employment

Check if employed

Occupation

Name of employer

Length of employment

Your work hours

Other household members' employer

Other household members' work hours

How many hours a day will your dog spend alone?

Your Household

Type of residence

House   Apartment/Condo

Own or rent? Check if you rent your residence

Landlord’s name, address and phone number:

Length of residency Please describe your neighborhood. Is your home in a city, town, country, or suburbs? Check if you have a fenced yard

Type of fence Fence height (in feet)

Number of children and their ages Are you or any members of your household allergic to animals? If YES, please describe: Do you travel for business or vacation? If YES, who will provide for your animal(s) while you are away?

About Adoption

Check if you have considered the daily expenses for maintaining an animal (food, vaccinations, monthly heartworm preventative, monthly flea/tick preventative, unexpected medical expenses, grooming, obedience classes, etc.) Check if you are able to bring all family members and pets to meet the dog you are considering?

If you are not able to bring all family members, why not?

Check if we may visit your home as part of the pre-adoption process. Check if you are willing to contact Shultz's Guest House if you cannot keep your him/her. Check if you agree to license and provide total health care for this dog.

Are you willing to adopt:	Yes	No
Dog that needs regular medication
Dog that needs grooming
Shy dog
Dog that needs training
None of these

Desired sex

Spayed Female   Neutered Male   No Preference

If you're interested in a specific dog, please name him/her here:

Information about Your Current and Former Pets

Please complete the following information for all current animals living in your home and former animals:

Dogs: please include breed, sex, age, disposition, and length of ownership. Please specify current/former Cats: please specify current/former Other: please specify current/former Check if your current pets are spayed/neutered. Check if your pets are current on vaccines, heartworm prevention and flea/tick prevention.

Name of vet practice

Name of veterinarian

Veterinarian Phone

If you have NOT owned a pet recently please list the name of the veterinarian you used when your owned your last pet or one you are planning on using.

Care of Adopted Dog

Where will this dog spend its day? Where will this dog spend its night? When the dog goes out, how do you plan to supervise? Check if you intend to crate this dog

When, why, and for how much time?

How would you train/discipline your pet? Please Describe:

References

List the Names, Addresses and Phone Numbers of two references (non-family members and non-veterinarian) we may call who can attest to your suitability as an adopter

We encourage adopters to consider their own needs, preferences, and capabilities before adopting any dog. Applicants must be at least 21 years old to adopt one of our dogs.

Check to confirm that you are 21 years of age, and that all of the information provided is true to the best of your recollection and knowledge.