First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Alt Email

Text/Pager Email

Name of dog interested in:
Choose an animal: DUDLY

Type of dog requested:

Reason for adopting:*
Choose one: Gift Companion Watch/Guard Dog Breeding Hunting Herding Other

If a gift or companion, please tell us more:

Are you at least 21 years old?*
Choose one: Yes No

What is your age?*
Choose one: 18-20 years old 21-30 years old 31-40 years old 41-50 years old 51-60 years old 61-70 years old 71 years or older

Are you currently a student?*
Choose one: Yes No

If yes, *
Choose one: Yes No N/A

Permanent address:*

How long have you been at your current address?*

Number of adults in household.*

Number of children in household:*

Please list all Adult residents in your home (including yourself). Be sure to provide Ages, and Relationships to you.*

Do you have Children in the home or Children who frequently visit your home? If yes, please provide their ages and relationship to you:*

How will the children be introduced to the dog?

Have the kids previously been around dogs?*
Choose one: Yes No

Do you plan on leaving the child alone with the dog?*
Choose one: Yes No

Who will be responsible for the new dog?*

Is everyone in the household willing to make a lifetime commitment to the new dog?*
Choose one: Yes No

If not, why?

Does anyone in the home have allergies? Yes or No. If yes, What kind of allergies?*

I live in a:*
Choose one: home apartment condo mobile home

That I*
Choose one: Own Rent Live with Parents Live with Roommates

If you rent, do you have your landlord's permission to have/own a pet?*
Choose one: Yes No N/A

Landlord's Name and Phone Number, if you own your home or live with parents, please enter your or your parents info:*

Do you have a yard?*
Choose one: Yes No

If yes, how big is the yard? Is it fenced?

If yard is fenced, what is the height?*

How will you confine the pet?

Tell us more about if you are planning to confine the pet to your property, as well as how you will confine the pet to your property. For example, if it's a cat, will it be inside only, or will you be training it on when it has to come in. If it's a dog, will you be crate training it, using a kennel, or do you have a secured yard, etc.*

Do you currently have other pets in the home?*
Choose one: Yes No

Do your pets go outside? If yes, explain:*

Please list all pets currently in your home. Please provide all details so we can ensure a great match.

For each of your pets, please provide the following: Name, Species, Breed, Age, Gender.*

Are your current pets spay or neutered? If not, why?

Have you ever owned dogs that you no longer own? (Yes/No). If so, please give a brief description of what happened to the dogs.*

Have you ever given up a dog? Yes/No. If yes, why?*

Have you ever adopted an animal from TCHS before? *
Choose one: Yes No

If so, do you still have it? (Yes/No) If not, why?*

How long do you usually keep a pet?*

Have you ever given up an animal due to moving?*
Choose one: Yes No

If yes, please explain:

What pets have you owned in the last 5 years that you do not currently own? Please tell us about these pets, the types of pets, including their ages, how long you owned them, and what happened to the pets.*

Do you own livestock animals? If so, please describe:*

If yes, please describe, if non applicable, please state N/A:*

Have you ever taken a dog through obedience classes?*
Choose one: Yes No

Would you be willing to take this dog through obedience classes?*
Choose one: Yes No

If you have owned a dog previously, how did you train it?

What personality traits are you looking for in a dog?*

In the past, what behavior problems have you experienced with companion animals and how did you solve them?*

How many hours each day will the pet be left alone?

Where will the pet be kept when alone?

Where will the pet be when you are home?

Where will the pet sleep at night?

Ability to exercise:

Other:

What, if any, of the following reasons would cause you to give up your dog:

Name of Vet and Phone number, if you do not have one please state that you will be looking for one to establish with:*

I understand that in order to be considered as an adopter I must:

• Be at least 21 years of age.
• Have a valid driver's license or other government issued ID.
• Have proof of the knowledge and consent of your landlord if renting.
• Be willing and able to provide proper care, training, and medical treatment.

I certify that all of the information provided in this application (in its entirety) is true and correct as of the date of submission, and I understand that my application may be denied if false information is given.

I agree that if the pet(s) being adopted does not work out for whatever reason, I will return the pet to TCHS. I understand that the submission of this form does not guarantee I will be approved to adopt a pet from TCHS.

I understand this application will be reviewed and evaluated based on what TCHS feels will be the best match for the pet(s) and for myself.

I agree*
Choose one: I agree