Name*
Address*
Daytime Phone:*
Evening Phone
Email Address:*
Applicant's Date of Birth*
Employer*
Occupation*
Please list the names of all the adults (over 18) in your home.*
Please list the names and ages of all the children in your home.*
What type of home do you live in?*
Apartment House - Rent House - Own Condo/Townhouse Other
How long have you been at this address?*
If you rent, please tell us the landlord's name and phone number.
Please rate the level of activity in your home.*
I never have visitors. I have occasional visitors. I have frequent visitors. I never know when visitors will arrive.
Please describe all the pets you currently have in your home.*
Excluding current pets, please describe all the pets you have had in the last 5 years.*
If you currently have a pet, who is your veterinarian?*
What kinds of activities will you do with your new dog?*
Have you ever adopted a pet from a shelter or rescue?*
No Yes, a dog Yes, a cat Yes, multiple pets
Have you ever given a pet to a shelter or rescue?*
No Yes, a dog Yes, a cat Yes, multiple pets
Have you ever moved to a new address with pets?*
Yes No
Do you expect to take your pets with you if you move again?*
Yes No Depends
Does your community have a leash law?*
Yes No Do Not Know
Does your community have breed specific legislation?*
Yes No Don't know
Please check all the qualities you WANT in your dog.*
Independent Athletic Likes other dogs Confident Affectionate Protective Very active Enjoys young children House trained Likes cats Good with livestock Moderately active Working potential Able to live outdoors Knows to stay in own yard
If you are applying for a specific dog, please name the dog.*
If you are not applying for a specific dog, do you have a gender preference?*
Male Female Doesn't matter
Preferred age:*
Under 4 mos 4 mos - 1yr 1 yr - 3 yrs 3 yrs - 7 yrs 7 yrs or older Doesn't matter
How much time per day, on average, will the dog be without human supervision?*
Less than 2 hours 2-6 hours 6-8 hours More than 8 hours
Where will the dog be kept when you are away from home?*
House Yard Yard with dog door Crate Crate at first, then run of the house Dog-proof room Basement/garage Doggie day care On a tie-out Pen with a dog house Other
If you have a secure fence, what is the fence height?*
If you have a fence, what type of fence is it?*
Solid wood Chain link Woven wire Barbed wire Electric Invisible Picket Not applicable
If your yard is not fenced, are you considering installing one? (Don't worry, having a fence is not a requirement!)*
Yes No
Are you considering attending dog training classes?*
Yes No
Have you considered the annual cost of caring for your dog?*
Yes, and I am prepared to pay for regular care that could exceed $500 Yes, but I can't imagine it will cost that much No, please tell me what annual care is required
How did you hear about the dogs at Animal Farm Foundation? (please be specific)*
Additional Comments:
Signature (please type name)*
To prevent spam, please answer the following question.
What is one added to five?*
