Enrollment Information

Application Information

First Name: Last Name:

Street Address:

City: State: Zip Code:

Home Phone number: Cell Phone number: Email Address:

Number of residents in home: Ages of residents:

Number and type of other pets in the home:

Do you live in a: House Townhouse Duplex Apartment

Do you have a fence? What kind of fence and height?:

Have you owned or cared for a dog before? Yes No

What breed?:

Have you ever given up a dog before? Yes No

If yes, What were the circumstances?

Have you ever potty trained a dog? Yes No

If yes, how did you potty trained the dog?

Have you ever crate trained a dog? Yes No

Do you use monthly preventative care (heartworm and flea and tick control)? Yes No

How often and how will the dog get exercise?

Where will the dog sleep?

Will the dog be allowed on the furniture? Yes No

What dog food do you use to feed your dogs?

What training will you provide for your dog?

How will you deal with any behavioral issues that the dog may exhibit?

Where will the dog stay when you are not home during the day?

May we contact your vet? Yes No

Vet name and phone number:

If you are interested in a certain dog, please identify:

What type of dog are you interested in?

Sex of dog: Male Female
Size of dog: Small Medium Large
Energy level: Low Medium High
Exercise Requirements: Low Medium High
Playfulness: Low Medium High
Affection Level: Low Medium High
Friendliness Towards Other Pets: Low Medium High
Friendliness Towards Strangers: Low Medium High
Ease of Training: Low Medium High
Grooming Requirements: Low Medium High
Potty training: I'm ok with potty training the dog I'd prefer a dog that is already potty trained The dog must be potty trained

Which one of our plans are you interested in?

A

Adoption: Our adoption fee is $200 and the dog will belong to your family. No continued care is provided.
B

Basic Care: Our basic care will include routine veterinary care and grooming services. We will pick up the dog and take them to the vet or groomer and return them to you. Your cost will be $240 a year or $20 a month recurring donation.
C

Complete Care: Our complete care will include routine veterinary care and grooming services as well as a monthly delivery of dog food and heartworm preventative. We will also watch your dog if you are on vacation or in the hospital or nursing home. Your cost will be $360 a year or $30 a month.

It is our mission to carefully match up the right dog with the right home and provide continued care if needed.

We will do a home visit to confirm the applicant's ability to care for the dog and verify that the environment is safe for the dog.

This enrollment information will be emailed to us and we will contact you and make arrangements for a home visit.