I am at least 19 years old
*
When are you looking to adopt?
*
Name of dog you're interested in
Where did you see this dog?
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
(###)
###
####
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?
*
You live in a:
*
Rent or own?
*
If renting, does lease permit dogs?
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?
*
Other pets currently in the house
*
If other dogs in house, provide breed, sex, age and describe temperament
Size dog looking for
*
Gender of dog looking for
*
Length of hair on dog you're looking for
*
Mixed breed ok?
*
List other qualties that are important to you
Veterinarian Reference (include location and phone number)
If you don't have a current vet, please list the most recent one you have used.
Personal Reference (name, number, and relationship)
Do you feel physically able to care for a dog for its lifetime?
*
In your absence, who will care for this dog?
*
I give my consent to the Baldwin Humane Society to contact the listed references. Any information obtained by Baldwin Humane Society will remain confidential.
*
