*** Dirty Paws Rescue, Inc. Application *** All information on this application is important to help us choose the right home for each pet and the right pet for each family. Please fill out all areas as honestly and to the best of your knowledge. All areas MUST be filled out or the application will not be considered for adoption.   PERSONAL INFORMATION
Full name:	* required
Age:
Phone #:	* required
Cell #:
Work #:
E-mail:	* required
Address:	* required
City:	* required
State:	* required
Zip:	* required
Employer:
Employer #:
Spouse/Partner/Roommate ** If information is the same as above, leave blank **
Full Name:
Age:
Relationship to above applicant:
Phone #:
Cell #:
Work #:
E-mail:
Address:
City:
State:
Zip:
Employer:
Employer #:
VET INFORMATION: ** If you do not have a vet you will need to provide the information to a vet office you plan to use before approval **
Vet Name:	* required
Vet Address:
Vet Phone #:	* required
Last Visit to Vet:
PERSONAL REFERENCE INFORMATION: ** When providing personal references please choose people that are not related to you **
Reference #1
Name:
Phone #:
E-mail:
How do they know you?
Reference #2
Name:
Phone #:
E-mail:
How do they know you?
Reference #3
Name:
Phone #:
E-mail:
How do they know you?
ENVIRONMENT:
Please list the names and ages of all the people living in the household:
1:
2:
3:
4:
5:
Is everyone in the household in agreement to the adoption of a new pet?
	Choose Yes No
Is the adoption of the pet going to be a surprise or gift for someone else?
	Choose Yes No
How long have you lived at your current address?
CURRENT LIVING SITUATION:
Do you live with your parents?	Choose Yes No
Do you live ...	Choose In an Apartment In a House In a Condo In a Mobile Home/Trailer
Do you live ...	Choose In the Country In the Suburban In the City
Do you rent?	Choose Yes No
Landlord's Name:
Landlord's Phone #:
*Does the area you live in have restrictions on the breed of dog you can own? (i.e Pit bulls, American Bulldogs, Rottweilers, etc...)
If yes, what breeds?	Choose Yes No
*If you own your home have you talked to your homeowners Insurance Company to find out if there are any restrictions in your policy about the type/breed of dog you can own?
If Yes, what did they tell you?	Choose Yes No
*How many pets are you allowed to have in your area according to the law?
Do you have a yard? Is it fenced?	Choose Yes No Choose Yes No
If yes, what type of fence and how tall is it?
Does it have a gate?	Choose Yes No
Can it be locked?	Choose Yes No
PETS LIVING SITUATION:
How many hours a day will the dog be left alone?
` If 8+, please explain ...	Choose Under 1 hour 2 to 4 hours 4 to 6 hours 8 + hours
Where will the dog be left while you are gone?
Where will the dog spend most of its time?
What food do you plan to feed the dog?
ADOPTION INFORMATION:
Why do you want a dog?
Have you ever owned a dog?
	Choose Yes No
Sex Preference:
	Choose Male Female No Preference
Age Preference:
	Choose Puppy (8 weeks thru 6 months) Young Adult (7 months thru 1 year) Adult (2 years +) Senior No Preference
If interested in a specific pet or are requesting to be put on our file for a certain breed, please put what or who you are applying for here.
Can you patiently handle house training and/or other behavioral issues?
If no, what issues can you not tolerate?	Choose Yes No
CURRENT AND PREVIOUSLY OWNED PETS
Please give the name, ages and type/breed of all the pets you currently have. Example: Name: Lily  Age: 1 year old   Type/Breed: American Bulldog  Where is the Pet Kept: In the house with our family
Current PET #1
Name:
Age:
Type/Breed:
Where is the Pet Kept:
Current PET #2
Name:
Age:
Type/Breed:
Where is the Pet Kept:
Current PET #3
Name:
Age:
Type/Breed:
Where is the Pet Kept:
More the 3 pets? Please add them here.
Are your pets spayed and/or neutered?
	Choose Yes No
Are your pets up to date on all their required vaccinations?
	Choose Yes No
Are your pets currently on Heartworm Preventative?
If yes, what type?	Choose Yes No
Please list all the pets you have had in the past 3 years that are not listed above. Where they are now and why? Example: Name: Brutus - Rottweiler  Age: 6 years old  Where & Why: Put to sleep 3/05 because of cancer
Previous Pet #1
Name:
Age:
Where & Why:
Previous Pet #2
Name:
Age:
Where & Why:
Previous Pet #3