Name of all Adults in the home: **  
Email Address:  * *
Street Address:  
City: * *  State:  * *  Zip Code:  **
Phone at Home:  * *  Phone at Work: 
Best time to call: 
Dog you are interested in:

Number of Adults in Home:  1 2 3 4 or more   Ages of Adults:  21-35 36-50 50 or above
Number of Children in Home:  0 1 2 3 4 or more     Ages of Children:  n/a 1-4 5-7 8-10 11-14 15-21  

Type of Home you live in:  House  Condo  Apartment
Do you:  Own  Rent/Lease
If you rent or lease, you will have to have written permission from your landlord.  Landlord's name and phone number: 

Is your yard fenced:  Yes  No
If yes, please describe fence: 
If no, would you be willing to put up a fence:  Yes  No

References  -  This section is not required, but no adoption will be approved without a reference check.  Remember, most of our babies have been abused or near death at some point in their lives.  We have spent much time, money, effort, and love and are not likely to put them in a bad situation again.

Vet Reference:    Phone Number:  
Personal Reference #1:    Phone Number: 
Personal Reference #2:    Phone Number:  
Personal Reference #3:    Phone Number: 

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