Adoption Application - Good Dog Rescue of Nebraska

Name

First NameLast Name

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Name of Dog you are interested in adopting.

What is your main reason for wanting to adopt a dog?

Please list all family members including children and their ages:

Do you own or rent a home?

What type of home?

Is your yard fenced?

Please describe what type of fencing and height of fence.

Do you currently have any pets?

Please list your current pets and their ages:

Are your pets spayed/neutered?

Are your current pets up to date on vaccinations?

Are your pets on heartworm preventative?

Please list your prior pets and what happened to them:

Have you ever given a pet away? If so, why?

Where will your pet be kept at night?

Where will your pet be kept during the day?

Will you crate your pet?

How many hours each day the dog will be home alone.

Who will be the primary caregiver of the dog?

Please list your current veterinarian Name, Address and Phone

Please list three (3) references, not including family members. Please provide their Name, Phone and Email

Good Dog Rescue of Nebraska requires a homevisit to meet your family. Are you willing to have a home visit?

Owning a dog can easily cost $1000 per year for good quality dog food, timely veterinarian visits for health checks or vaccination updates, and the occasional needed trip to the veterinarian for accidents. Are you willing and able to provide for this level of care for your dog?

How would you describe your activity level - low activity, moderate activity, high activity?