Telephone   (home)   (work)   (cell)

Best time / place to call home work cell

Occupation

I certify that I am at least 18 years old.

How did you hear about Muttville?

Why do you want to have a dog?

What Muttville dog(s) are you interested in?

Do you prefer a:   male   female   either is ok

What size dog do you prefer:   small   medium   large any size is ok

What breeds have you been considering?

What personality traits do you want your dog to have?

Are you willing to adopt a special needs dog?

Where will the dog stay when you're at home during the day?

Where will the dog stay when you're out during the day?

Where will the dog sleep at night?

How long will the dog be alone (without humans)?   hours per day   days per week

How will the dog receive exercise? (Check all that apply.)

            Fenced yard   Daily walks   Dog park   Other

Are you willing to hire a dog walker to provide exercise and potty breaks for your dog
            while you're away during the day? select Yes No

When you are away (vacation, business travel, etc.), what will happen with the dog? (Check all that apply.)

            Travel with you   Kennel   Pet sitter   Other

In what activities do you plan to participate with this dog?

Are there any areas of your home where the dog will not be allowed? (Please specify.)

Will the dog be allowed on the furniture?

How much time and effort are you willing and able to spend training your dog?

Are you willing to attend training classes with your dog? select Yes No

How will you discipline your dog?

Who will be responsible for:   Feeding   Exercise

Who will be responsible for:   Vet care   Training

Who will be responsible for:   Cleaning up

Is any member of your household allergic to dogs? select Yes No

Do you (or anyone in your household) have any health conditions, physical limitations, or other special needs that we should consider in finding the right dog for you? (Please explain.)

Are you aware that dogs want to be family companions; therefore, they need attention and human companionship, and may develop behavior problems if left alone for long periods of time? select Yes No

How many adults (18 or older) live in your home? select 1 2 3 4 5 6+

Please supply names and ages of all adult occupants, including you.

How many children (under 18) live in or frequently visit your home? select 0 1 2 3 4 5 6+

What are the ages of these children?

If living with other adults, how do they feel about having a dog?

Do you live in a:   house   condo   apartment   other

Do you:   own   rent

Do you have stairs inside or leading into your home? select Yes No

How many?

Do you have a yard? select Yes No   Size

Is it fenced? select Yes No   If so, how high is the fence? Can children open gates? select Yes No

Have you inspected the fence for holes the dog might get through? select Yes No

Do you have a pool? select Yes No   Is it fenced? select Yes No   Can the dog get to it? select Yes No

Will you allow us to visit your home? select Yes No

Do you currently have other pets? select Yes No

Please supply the following information for each pet you currently have or have had in the past 10 years.

DOGS

Name   Breed   Age   Sex select Male Female   Spayed/neutered select Yes No

How long have you had this dog?   Where did you get him/her?

Do you still have this dog? select Yes No

If not, what happened to it?

Name   Breed   Age   Sex select Male Female   Spayed/neutered select Yes No

How long have you had this dog?   Where did you get him/her?

Do you still have this dog? select Yes No

If not, what happened to it?

Name   Breed   Age   Sex select Male Female   Spayed/neutered select Yes No

How long have you had this dog?   Where did you get him/her?

Do you still have this dog? select Yes No

If not, what happened to it?

Are all dogs current on shots? select Yes No

CATS

Name   Breed   Age   Sex select Male Female   Spayed/neutered select Yes No

How long have you had this cat?   Where did you get him/her?

Do you still have this cat? select Yes No

If not, what happened to it?

Name   Breed   Age   Sex select Male Female   Spayed/neutered select Yes No

How long have you had this cat?   Where did you get him/her?

Do you still have this cat? select Yes No

If not, what happened to it?

Are all cats current on shots? select Yes No

OTHER PETS

Please describe any other pets you currently have.

Have you ever had a dog before? select Yes No

Are you familiar with monthly preventative care (such as flea, tick and heartworm control)? select Yes No

Do you have experience dealing with behavioral issues? select Yes No

Have you ever given up a dog? If yes, please explain the circumstances.

Please provide a personal reference:

            Name   Phone   Relationship

Veterinarian used in the past 5 years. May we ask this vet for a reference? select Yes No

            Name   Hospital

            Address   Phone

Is there anything else you'd like us to know about you or the kind of dog you want to adopt?

CERTIFICATION

I certify that, to the best of my knowledge, the information provided in this application is true and complete. I recognize that any misrepresentation of that information will result in my losing the privilege of adopting a rescued dog from Muttville. I understand that Muttville has the right to deny my request to adopt a dog, and I authorize checking all information provided in this application.