Address


*Please provide an email address that you check regularly as this is how we will contact you. Don't forget to check your junk/spam folder as well.

Does anyone in your household have allergies to animals? *
YesNo

Do you: *
OwnRentLive With ParentsOther

Does your yard have a physical or electric fence? *
YesNo

Do you have a doggie door?
YesNo

Do you currently have pets? *
YesNo

Are you willing to give this pet at least 2 weeks (some may take 30 days or more) to adapt to its new environment and family members? *
YesNo

A special needs dog may have a handicap, short term health issues, long term health issues, or may be a senior. *

An adoption fee is charged by us to offset the cost of the dog's care while with our rescue. Is payment of this adoption fee acceptable to you? *
YesNo

We require a home visit for any adoption. Do you agree to this? *
YesNo

**By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I also certify that the above is true and accurate to the best of my knowledge. I also understand that the above information will be verified.

I understand that applying does not ensure approval and that untruthful answers, false or misleading information, or failure to comply with the requirements of this application can result in rejection of my application and/or may be considered justification for the removal of my adopted dog if discovered at a later date.**

Date (MM/DD/YYYY):

Time: