Help4Pets

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
E-mail

Which dog are you interested in adopting?

Driver's License Number & State

Reference Information

Employer
Title or Position
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Personal Reference
Phone

Why are you considering adding a pet to your life?

        Companion for Children  
            Companion for Adults Only  
                Companion for the Whole Family  
                    Protection for Home/Family  
                        Working Dog  
                            Companion for Other Pets  
                                Other
                                   

How many people live in your household? 

Do all members of the household want a pet? Yes No

Do any family members have allergies or asthma? Yes No

If you have children, what are their ages? 

Will this animal be given as a gift?  Yes No

Have you ever owned a pet before?  Yes No

If yes, how long did you have your pet(s)? 

If no longer with you, what happened to him/her? 

What other pets live with you?

Dogs (number)
Age(s)
Spayed/Neutered?
Breed(s)

Cats
Other Pets

Do you own or rent your home? Own Rent

Do you have a yard? Yes No

Is the yard fenced? Yes No

What is the approximate height of the fence (feet)? 

Do you have a pool? Yes No

Is there a fence around it? Yes No

Where will the pet be kept when you are not home? Indoors Outdoors

If outdoors, will your pet be tied up or chained in any way? Yes No

On average, how many hours a day will your pet be left alone? 

Do you have the time and knowledge to train your new pet should a behavior problem arise? Yes No

Remember that pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, adequate shelter, and exercise for your new pet? Yes No

Veterinarian Reference (Name & City):

If arrangements don't work out with your new pet, are you willing to return it to its original owner? Yes No