Dog Matchmaker Form

Dog Matchmaker Form

Anthem Pets Animal Rescue
Dog(s) of Interest:*
Your First Name:*
Your Last Name:*
Significant Other's First and Last Name:(optional)*
Your e-mail address:*
Your Home Address:*
City:*
State:*
Zip Code:*
Home Phone:*
Cell Phone:*
Work Phone:
Your Occupation:*
Your Employer:
Name of Current Veterinarian:*
Current Veterinarian's Phone:*
How long have you lived in Arizona:*
How long have you lived at your current residence:*
Do you live in:*

HouseCondo / TownhomeApartmentMobile Home
Do you own or rent your home*

OwnRent
Landlord/Apartment Complex Name:(required if you rent)*
Landlord/Apartment Complex Phone Number:(required if you rent)*
If you rent, have you paid the pet deposit (required if you rent) *

YesNoNot applicable
Are you planning to move soon*

YesNo
Does your home have a pet door to the outside*

YesNo
Is your yard fenced*

YesNoNot applicable
What type of fencing do you have*

BlockWoodChain linkOtherOption5
How many children live in your home and what are their ages:*
How many adults live in your home:*
Is anyone in your home allergic to cats and/or dogs*

YesNo
Is the animal a gift*

YesNo
What do you want your dog to be*

Indoor OnlyOutdoor OnlyBoth
If you selected both, please choose how much time the dog will spend outside*

25% of the time50% of the time75% or moreJust for playtime
Gender preference for dog*

MaleFemaleNo preference
Age preference*

Under 6 months0-1 year old1-2 years old2-4 years old4-6 years old6 or more years oldNo preference
Breed Preference*

YesNo
If yes, please explain
Fur length preference*

LongMediumShortNo preference
What size dog *

Small (under 25 pounds)Medium (25-40 pounds)Large (40 pounds or more)No preference
What type of activity level will you want from this dog *

High activityMedium activityLow activityNo preference
You want the new dog to do the following with you and your family*

HikeTravelJogCampBicycleSwimRelax in the eveningPlay with kidsPlay ballLap dog/mellow companionOther
You want your new dog to be *

CompanionObedientServiceProtectivePerformer (agility)Other
What would cause you to return this pet*

AllergiesChange in marital statusNew BabyAggressivenessVet billsJob changeMovingHealth IssuesDestructive BehaviorsNot compatible with other petsHouse trainingKids not taking care of petNoneOther
When you travel or go out of town, you plan to*

Take the dog with youBoard the dogLeave home with friends or familyHire a pet-sitterLeave dog alone
Are you familiar with crate training*

YesNo
Will you crate train*

YesNoMaybe
List all the pets you currently have. If there are more than three that's OK, just use the space at the end to list any additional pets.
Pet #1
Pet Species
Pet Name
Vaccinated

YesNo
Pet spayed or neutered

YesNo
Pet #2
Pet Species
Pet Name
Vaccinated

YesNo
Spayed or Neutered

YesNo
Pet #3
Pet Species
Pet Name
Vaccinated

YesNo
Spayed or Neutered

YesNo
List additional pets here
Please check the reason you want to adopt a pet *

CompanionshipShow dogPlaymate for childrenPlaymate for pet(s)
Have you ever had to surrender a pet to a rescue or shelter*

YesNo
If yes, please explain
If your dog develops a medical condition that exceeds $500 in vet care, what will you do*
Have you ever adopted from another shelter. If so, please list the name of the shelter(s)*
How did you hear about Anthem Pets*
Additional Comments
You agree to allow us to visit your home by appointment as part of the application process*

Yes I agree to a home visit
All of the information I/we provided in this application is true and correct. I understand that submission of an application does not guarantee I will be selected to adopt this animal *

Yes I agree that all information is true
All members of Anthem Pets are volunteers. We will try to respond to your request as soon as possible, but please be aware that it could take a day or two. Thank you for your patience!
NOTE: Occasionally users of mobile devices or tablets will experience errors when completing the form. If you are unable to submit, please email Rescue@AnthemPets.org.
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