Pet Name for who you'd like to adopt:*

Your First and Last Name:*

Your Age:*

Your Occupation:*

Name, Age, Occupation of other Adults in the home:*

Street Address:*

City / State/ Zip:*

Your Email:*

Retype Your Email to make sure correct!:*

Home Phone:*

Cell Phone:*

Is this pet for you, your family or a gift for someone else?*

-Select One-MeGiftFamily

What kind of pet are you looking for?*

CompanionFamily PetChilds PetFriend for other petGift

Why would you like to adopt a pet?*

Please tell us what you would consider to be the perfect pet. What personality are you looking for?*

Ages of children living with you:

Ages of children who often visit you:

Names, Breed, Type, Age, Sex, and Weight of any pets you have:*

Where do these pets sleep at night?*

Are all your pets spayed / neutered?*

-Select One-YesNoHave no pets

If pet(s) are not spayed/neutered, why not?

Are all your pets vaccinated?*

-Select One-YesNoHave no pets

Are all your dogs current on heartworm medication?*

-Select One-YesNoHave no pets

How do you feel about heartworm prevention? What do you know about heartworms?

Have you had pets other than those listed above in the past 5 years? If so, what kind of pet and what happened to them?

Do you own or Rent?*

-Select One-OwnRentLive with parents

Do you live in house, apartment, etc:*

-Select One-HouseDuplexCondoApartmentTrailerOther

If you rent, do you have approval from your landlord to have a pet?*(we will contact to make sure)

-Select One-YesNoI own my home

Will this dog be allowed in the house?*

-Select One-YesNoSometimes

Where will this dog be when left alone at home? Be descriptive. (even if you think you will never leave the dog, at some point you will have to. Will dog be outside, inside, in a crate, in a room, etc.).*

How long will the dog be left alone during the day? Describe if dog gets a break within this time.

Where will this dog be when you are home?

Where will this dog sleep at night?

Do you have a fenced yard?*

-Select One-YesNoPartially

If so, what kind (stockade/chainlink/etc)?

If so, how high?

Do you have a doggy door?*

-Select One-YesNo

How often do you plan to walk the dog?*

How will you socialize the dog?*

When you travel, who will care for the pet while you are gone?*

Under what circumstances would you not keep the pet?*

movingdivorcedigginghousetraining problembarkingpet illnot obedience enoughaggressionshedding too muchallergiesgrew too bigpets didn't get alongjump fenceothernone of the above

Please explain above reasons:

If the pet becomes ill or injured, are you financially prepared to provide the medical care?*

-Select One-YesNo

How much do you expect your pet to cost monthly?*

The pet may live 15+ years, what would you do with your pet if you could no longer care for the pet?*

Name / Phone of your Vet / Clinic*

Any Additonal Comments to Describe the life this Dog would have with you:

I/We agree that the animal will be in my home and will not be sold, gifted, or otherwise given to a third party for any reason.

I/We agree to these terms

I/We agree to treat the animal humanely and will provide it adequate food, water, shelter, attention and interaction.

I/We agree to these terms

I/We agree that the animal will not be kept outside for extended periods of time under any circumstances, whether in the extreme cold or heat, over night or while away from your home for various reasons.

I/We agree to these terms

I/We agree to never leave the animal tethered or chained up outside.

I/We agree to these terms

By checking below you agree that all of the above information given above is correct, and that you authorize Forever Yours Dog Rescue to verify any information.

I/We agree to these terms