Pet's Name:
First Name:		Last Name:
E-mail:
Address:
City, State, Zip:

Cell Phone:

Work Phone:

Home Phone:

Are you 18 years old or older? Yes No

Do you live in a home townhome or apartment?      Do you own or rent your home?

If you rent, do you have written permission from your landlord to own a pet? Yes No

If renting, landlord's name and phone:
How long have you lived at this address?:		Do you have plans to move?:

FAMILY/HOUSEHOLD INFORMATION
Are there children in the household? Yes No		What are their ages?
Is anyone in the household allergic to dogs? Yes No
Do you expect your current family situation to change?: Yes No
Are all family members in agreement about this adoption? Yes No
Why are you considering adopting a dog?
Companion for self	Companion for child	Companion for another household member	Watchdog	Gift
Other reason for adopting:
It's most important to me that my dog:

PET INFORMATION
Have you had pets in the past or do you currently have pets? Please tell us about them
Name	Breed	Age	Gender	Spayed/Neutered?	If still alive, where are they?
			M F	Y N
			M F	Y N
			M F	Y N

Have you ever given a pet away or taken a pet to a shelter? Yes No

If yes, what were the circumstances?

VETERINARIAN INFORMATION

Veterinarian's name and phone:

When was your current pet's last visit to a veterinarian and why?:

May we contact your vet as reference? Yes No

NEW PET INFORMATION

What are you considering feeding your dog?:

How often will you feed it?

Are you willing to spend $200-$500 for emergency veterinary care? Yes No

If you move, what do you plan to do with your pet(s)?

Who in the household will be the dog's primary care giver?

Where will your dog be during the day? At night?

How many hours each day will the dog be unattended?

Do you have a fenced yard? Yes No If Yes, how high?

If No, how do you plan to contain the dog?

Do you own a pickup truck? Yes No If yes, where will the dog ride? If in the back, how will you restrain your dog?

Do you or your neighbors own livestock, farm or exotic animals? Yes No

If this dog is not housebroken, how will you train your new dog?

If behavior problems do present themselves at a later date, will you be committed to working with the animal to correct the problem? Yes No

How did you first hear about this dog?
Adoption Day	Sarge website	Petfinder.com	Facebook
Mountaineer	Smoky Mountain News	Asheville Citizen-Times
Other
Comments:
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