Adoption Form Dog4u Adoption App What is your name?* First Last Email* Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Best Phone to Reach You*Your Age*Please enter a number from 1 to 150.Co-Applicant's Name First Last Co-Applicant's AgePlease enter a number from 0 to 150.Dog type or name Is there a specific dog type or a particular dog that you're interested in learning more about? If so please enter the type of dog or the dog's name here.Please describe your housing*Please ChooseOwn Single Family HomeOwn Condo or ApartmentOwn Mobile HomeRent Single Family HomeRent Condo or ApartmentRent Mobile HomeOtherPlease describe "other" housing* Landlord's Name* Name Enter landlord's first and last name or name of company you rent from.Landlord's PhoneYears at present address?*Please enter a number from 0 to 100.For twenty three months or less, enter zero or one (0 or 1).Previous Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List each child's name and age*NameAge List all children who live with you part or full time. If NONE enter NONE on first line.All other household members*NameAgeRelationship to You List all other members of your household who live with you even one day a year or more. If NONE enter NONE on first line.Do you have a fenced yard for your dog?*Please ChooseCompletely fenced and lockedCompletely fenced but not lockedPartially fencedUnderground fence (we do not recommend)Planning to install a fence.OtherPlease note that electric fences use electric shock to punish your dog into staying put. They are inhumane.Have you ever owned a pet?* Dog Cat Bird Fish Reptile Small and furry Horse Other I've never owned a pet What happened to your past pets?*NameSpeciesLost? Died? How? How did your pets leave you? If this question doesn't apply put NA in the first line.List all pets who will live in same home as the dog*NameSpecies If the dog will be the only animal enter NA on the first line.Your CURRENT Vet's Name and Clinic Name* If you don't have a CURRENT vet enter NA.Vet's Phone*Your Pets at CURRENT Vet's Office* List the names of animals your current vet has treated.PREVIOUS Your Vet's Name* If you don't have a PREVIOUS vet enter NA.PREVIOUS Vet's Phone*Pet's Names at Previous Vet's* List the names of pets your previous vet treatedWhy do you want to bring a new pet into your home?*Is everyone in your household in agreement about getting a new pet?Please ChooseYesNoWho is having doubts and why?*Where will this pet spend most of its time?*Please ChooseInside freeInside cratedOutsideOtherWhere will the pet spend most of its time?*Who is home during the day and when?*Who is home during the evening and night and when?*What provisions will be made for your pet when no one is home?*What provisions will be made when you go on vacation?*Are you willing to provide training for your pet (obedience, housetraining)*Do you know of a trainer or place that provides training in your area?*Are you planning on particular activities with your pet? Please explain.*If you are adopting a dog, are you planning for it to be a guard dog?*Please ChooseYesNoNot applicableHow much do you believe a pet costs per year?*Under what circumstances would you give up your pet?*Do you have any questions or comments?Do you agree to a home visit before and after adoption? Yes No Please give me more information CommentsThis field is for validation purposes and should be left unchanged.