I am at least 19 years old
*
Yes
No
Name of dog you're interested in
If not interested in a specific dog, please describe what you are looking for
Name
*
First Name
Last Name
Applicant Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Email
*
Employer Name
First Name
Last Name
Co-Applicant Name
First Name
Last Name
Co-Applicant Relationship to Applicant
Co-Applicant Email
Co-Applicant Phone
(###)
###
####
When are you looking to adopt?
*
Right away
In a few weeks
Over a month
How many dogs and cats have you owned before?
If you no longer own them, what happened to them?
What Heartworm preventative are your current dogs taking?
How long at current address?
Do you agree to a home visit pre-adoption and post-adoption?
*
Yes
No
You live in a:
*
House
Apartment
Mobile Home
Rent or own?
*
Rent
Own
If renting, does lease permit dogs?
Yes
No
Landlord name and phone number
If approved for adoption, where will this dog spend the day?
Size of yard
Is yard completely fenced in? If yes, what material and height?
Number of adults in the home (19+)
Number of children and ages
Anyone allergic to dogs?
*
Yes
No
Other pets currently in the house
*
Dogs
Cats
Birds
Other
If other dogs in house, provide breed, sex, age and describe temperament
Where did you see this dog?
Size dog looking for
*
Small
Medium
Large
Gender of dog looking for
*
Male
Female
Length of hair on dog you're looking for
*
Short
Medium
Long
Breed looking for...is mix ok?
List other qualties that are important to you
Current Vet Information -- Name, Address, City, State & Zip
Current Vet Phone Number
(###)
###
####
Personal Reference #1 -- Name and Relationship
Personal Reference #1 Phone Number
(###)
###
####
Do you feel physically able to care for a dog for its lifetime?
*
Yes
No
Please tell us anything else you would like us to know about you, your home, your family or application
I give my consent to the Baldwin Humane Society to contact the listed references. Any information obtained by Baldwin Humane Society will remain confidential.
*
Yes
No