Below are three areas for information on other members of your family. Please include all other adults , children and pets living in your home by clicking on the designated button.
Adults Are There Other Adults (18+) In The Home? How Many?* Select Option 1 2 3 4
Adult 1 Legal First Name*
Last Name*
Age*
Gender* Select Gender Male Female Non-Binary
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other
Please Describe*
Adult 2 Legal First Name*
Last Name*
Age*
Gender* Select Gender Male Female Non-Binary
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other
Please Describe*
Adult 3 Legal First Name*
Last Name*
Age*
Gender* Select Gender Male Female Non-Binary
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other
Please Describe*
Adult 4 Legal First Name*
Last Name*
Age*
Gender* Select Gender Male Female Non-Binary
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other
Please Describe*
Children Are There Children In The Home?* How Many?* Select Option 1 2 3 4
Child 1 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 2 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 3 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 4 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Dogs Have You Had a Dog in the Past 2 years Including Dogs That Have Passed, Rehomed etc.?* List all dogs separately that have lived in the home in the past 2 years, Including Dogs Deceased and Currently in the Home How Many?* Select Option 1 2 3 4
Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?* Select Answer Dog Walker Dog Sitter Other
Please Describe*
Dog 1 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of My Dog Shelter Rescue Stray Pet Store Breeder Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned?*
This field is hidden when viewing the form
How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Age of Dog When Passed or Rehomed, etc.*
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Great Pyrenees Australian Shepherd Retriever - Black Labrador Retriever - Chocolate Labrador Retriever - Golden Retriever - Labrador Retriever - Yellow Labrador Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Chesapeake Bay Retriever - Curly-Coated Retriever - Flat Coated Retriever - Nova Scotia Duck Tolling Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Great Pyrenees Mix
Age*
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the dog.*
Current Dog Sleeping Quarters* Select Sleeping Quarters Free Roaming in House Crate Other
Please Explain*
Where do you keep the dog during times nobody is home?*
Is this Dog Used to Being Around Other Dogs?* We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On All Vaccines including Rabies & Distemper for Dogs?* Why Not?*
Heartworm Test Annually?* Up To Date On Heartworm Prevention Year Round?* Please provide product name*
Up To Date on Flea/Tick Prevention Year Round?* Please provide the product name*
Is There Any Additional Information You Would Like to Add?
Dog 2 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of My Dog Shelter Rescue Stray Pet Store Breeder Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned?*
Age of Dog When Passed or Rehomed, etc.*
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Great Pyrenees Australian Shepherd Retriever - Black Labrador Retriever - Chocolate Labrador Retriever - Golden Retriever - Labrador Retriever - Yellow Labrador Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Chesapeake Bay Retriever - Curly-Coated Retriever - Flat Coated Retriever - Nova Scotia Duck Tolling Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Great Pyrenees Mix
Age*
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the dog.*
Current Dog Sleeping Quarters* Select Sleeping Quarters Free Roaming in House Crate Other
Please Explain*
Where do you keep the dog during times nobody is home?*
Is this Dog Used to Being Around Other Dogs?* We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On All Vaccines including Rabies & Distemper for Dogs ?* Heartworm Test Annually?* Up To Date On Heartworm Prevention Year Round?* Please provide product name*
Up To Date on Flea/Tick Prevention Year Round?* Please provide product name*
Is There Any Additional Information You Would Like to Add?
Dog 3 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of My Dog Shelter Rescue Stray Pet Store Breeder Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned?*
Age of Dog When Passed or Rehomed, etc.*
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Great Pyrenees Australian Shepherd Retriever - Black Labrador Retriever - Chocolate Labrador Retriever - Golden Retriever - Labrador Retriever - Yellow Labrador Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Chesapeake Bay Retriever - Curly-Coated Retriever - Flat Coated Retriever - Nova Scotia Duck Tolling Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Great Pyrenees Mix
Age*
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the dog.*
Current Dog Sleeping Quarters* Select Sleeping Quarters Free Roaming in House Crate Other
Please Explain*
Where do you keep the dog during times nobody is home?*
Is this Dog Used to Being Around Other Dogs?* We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On All Vaccines including Rabies & Distemper for Dogs ?* Heartworm Test Annually?* Up To Date On Heartworm Prevention Year Round?* Please provide product name*
Up To Date on Flea/Tick Prevention Year Round?* Please provide product name*
Is There Any Additional Information You Would Like to Add?
Dog 4 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of My Dog Shelter Rescue Stray Pet Store Breeder Other
Please Explain*
Is Dog Still Living With You?* Which Years Owned?*
Age of Dog When Passed or Rehomed, etc.*
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Great Pyrenees Australian Shepherd Retriever - Black Labrador Retriever - Chocolate Labrador Retriever - Golden Retriever - Labrador Retriever - Yellow Labrador Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Chesapeake Bay Retriever - Curly-Coated Retriever - Flat Coated Retriever - Nova Scotia Duck Tolling Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Great Pyrenees Mix
Age*
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the dog.*
Current Dog Sleeping Quarters* Select Sleeping Quarters Free Roaming in House Crate Other
Please Explain*
Where do you keep the dog during times nobody is home?*
Is this Dog Used to Being Around Other Dogs?* We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On All Vaccines including Rabies & Distemper for Dogs ?* Heartworm Test Annually?* Up To Date On Heartworm Prevention Year Round?* Please provide product name*
Up To Date on Flea/Tick Prevention Year Round?* Please provide product name*
Is There Any Additional Information You Would Like to Add?
Cats Have You Had a Cat in the Past 2 years Including Cats That Have Passed?* List all Cats that have lived in the home in the past 2 years, Including Cats Deceased and Currently in the Home How Many?* Select Option 1 2 3 4
Cat 1 Cat's Name*
Is Cat Still Living With You?* Which Years Owned?*
How Old Was the Cat When It Passed, Rehomed, etc?*
Why not?* Select Option Died of Natural Causes Euthanized Rehomed Cat Ran Away Other
If Other, Please describe*
If Rehomed, Please Describe*
Age*
Gender* Select Option Female Male
Status* Select Option Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the cat.*
Inside, Outside, or Both?* Select Option Inside Outside Both
We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On FVRCP and Rabies vaccines?* Describe why not?*
This field is hidden when viewing the form
Vaccinated Annually?* Up To Date on Flea/Tick Prevention Year Round?* This field is hidden when viewing the form
If yes, Please Provide Product Name*
Why Not?*
Is There Any Additional Information You Would Like to Add?
Cat 2 Cat's Name*
Is Cat Still Living With You?* Which Years Owned?*
How Old Was the Cat When It Passed, Rehomed, etc?*
Why not?* Select Option Died of Natural Causes Euthanized Rehomed Cat Ran Away Other
If Other, Please Describe*
If Rehomed, Please Describe*
Age*
Gender* Select Option Female Male
Status* Select Option Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the cat.*
Inside, Outside, or Both?* Select Option Inside Outside Both
We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On FVRCP and Rabies vaccines?* Describe why not?*
This field is hidden when viewing the form
Vaccinated Annually?* Up To Date on Flea/Tick Prevention Year Round?* If yes, Please Provide Product Name*
Why Not?*
Is There Any Additional Information You Would Like to Add?
Cat 3 Cat's Name*
Is Cat Still Living With You?* Which Years Owned?*
How Old Was the Cat When It Passed, Rehomed, etc?*
Why not?* Select Option Died of Natural Causes Euthanized Rehomed Cat Ran Away Other
If Other, Please Describe*
If Rehomed, Please Describe*
Age*
Gender* Select Option Female Male
Status* Select Option Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the cat.*
Inside, Outside, or Both?* Select Option Inside Outside Both
We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On FVRCP and Rabies vaccines?* Describe why not?*
This field is hidden when viewing the form
Vaccinated Annually?* Up To Date on Flea/Tick Prevention Year Round?* If yes, Please Provide Product Name*
Why Not?*
Is There Any Additional Information You Would Like to Add?
Cat 4 Cat's Name*
Is Cat Still Living With You?* Which Years Owned?*
How Old Was the Cat When It Passed, Rehomed, etc?
Why not?* Select Option Died of Natural Causes Euthanized Rehomed Cat Ran Away Other
If Other, Please Describe*
If Rehomed, Please Describe*
Age*
Gender* Select Option Female Male
Status* Select Option Neutered Spayed Not Altered
Please Explain Why Not*
Provide a brief description of the personality of the cat.*
Inside, Outside, or Both?* Select Option Inside Outside Both
We do not as a matter of policy adopt dogs to homes whose pets have not been kept current on vaccines and preventatives or that have pets not spayed/neutered. We understand there may be exceptions to this rule which will require explanation. By way of example, veterinarians sometimes recommend not re-vaccinating immune compromised dogs and elderly dogs with significant health issues. We understand that and will confirm with your vet. Spay/neuter is extremely important to us and the circumstances in which an unaltered pet would be acceptable are limited. It is important that you keep your pet(s) up to date on vaccines and use heartworm preventatives year-round and we check it with your vet, so if you buy your heartworm prevention or flea and tick protection from someone other than your vet, please let us know. We accept current titer testing records in lieu of some vaccinations. Please make sure your vet has permission to release this information to us.
Up To Date On FVRCP and Rabies vaccines?* Describe why not?*
This field is hidden when viewing the form
Vaccinated Annually?* Up To Date on Flea/Tick Prevention Year Round?* If yes, Please Provide Product Name*
Why Not?*
Is There Any Additional Information You Would Like to Add?
Other Animals Are There Other Animals In The Home or on the Property (Include Any Livestock and Free Roaming Pets)?* How Many?* Select Option 1 2 3 4
Other Animal 1 Animal Type*
Sleeping Quarters*
Is There Any Additional Information You Would Like to Add About This Animal?
Other Animal 2 Animal Type*
Sleeping Quarters*
Is There Any Additional Information You Would Like to Add About This Animal?
Other Animal 3 Animal Type*
Sleeping Quarters*
Is There Any Additional Information You Would Like to Add About This Animal?
Other Animal 4 Animal Type*
Sleeping Quarters*
Is There Any Additional Information You Would Like to Add About This Animal?
