Adoption Application

Name

First

Last

Home Phone

Cell Phone

Email Address

Confirm Email

Gender

Birthdate

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

City

State

Zip Code

Dog Preference

Are there children in the home? If so ages

Have you owned a dog before

years How 375.00

If yes, Name and Phone number Veterinarian

Other animals in the home (If so please list)

What kind of daily exercise will you provide your dog

What do you estimate the yearly expense of owning a dog

Who will be the primary care giver of the dog

Where will your dog be when your family is home

Where will your dog be when your family is not home

How long will your dog be left alone at a time

Do you have a fenced in yard

Are you familiar with heart worm prevention and its associated costs

ARE YOU WILLING TO GIVE A RESCUED DOG AT LEAST TWO (2) MONTHS TO ADJUST TO YOU/YOUR FAMILY AND THEIR NEW ENVIRONMENT

Minimum donation 400 for dogs under one (1) year

Price: $400.00

Minimum donation 375.00 for dogs one (1) to six (6) years

Price: $375.00

Minimum donation 250 for dogs seven (7) to nine (9) years

Price: $250.00