CRAZY PAWS DOG RESCUE ADOPTION APPLICATION

        First Name:

        Last Name:

        First Name :

        Last Name :

Contact Information:

Street Address:

City: , State , Zip:
Occupation:

Email:

Additional Email:

Phone Numbers with area code:
       1st:          2nd:          3rd:

Household Information:

Number of Children: Ages of Children:

Number of Adults: Ages of Adults:

Housing Situation (House, Apt., Trailer, etc): Own or rent:

Landlord's Name: Landlord's Phone Number:

Where will the dog primarily be kept?

Is someone home during the day?

Is someone home at night?

If no to one or both questions, how many hours will the dog be alone?

            -----------------------------------------------------------------------------------------------------------------------------------------------------------------

Where is the dog going to stay:

During the Day? At Night?

     Do you have a completely fenced-in yard (Yes/No)?
     If so what type of fence and/or how tall is it?


Current and Past Pets:
     What animals are currently living with you?      (Name, Type, Age, Spayed or Neutered)


     Do/Did you use heartworm prevention medication on current or past pet(s)?        If so, what brand?
     Do/Did you use flea and tick prevention medication on current or past pet(s)?      If so, what brand?

     Please list any pets (dogs and cats) that you have had within the past 5 years not listed above.
     What happened to them? (If given away or euthanized, please explain)

     Rate your level of experience in dog ownership
      Beginner, Intermediate, Advanced (Please explain how you arrived at that level):

     Do you have any experience with obedience training? .........................................................
     Are you willing to hire a dog trainer or behavioral specialist if problems develop? ........
     How do you plan do provide the proper level of exercise for the dog? ..............................
     How will you discipline the dog when needed? ....................................................................
     If Applicable, what brand of dog food do/did you use? .........................................................

Veterinary Care:
    (Please understand that the information provided in this section is of vital importance to CRAZY PAWS)
    A dog must be seen by a veterinarian at least once a year for a check up, it must receive immunizations as
   recommended, be tested for heartworm & lyme disease (commonly know as the 4DX test) and be on
   heartworm prevention as recommended by your Vet.

    Are you willing to commit to this level of care? ........................................
    A volunteer will contact your Veterinarian(s) to affirm that your pet(s) past or current received the proper level of care.
         Veterinarian Name 1st            Vet Phone 1st
         Veterinarian Name 2nd           Vet Phone 2nd

    Why do you want a dog?

     If there is a particular dog you are interested in, please list name(s):



What behavior traits or strenghts are you looking for in a dog? (Please indicate with a yes/no)

Playful Friendly

Obedient Affectionate

Travels Well Easy to Train

Good with Children Does Not Chew

Good with Dogs Good with Cats

House Trained Does Not Shed

Good in Crate Energy Level(Low/Medium/High)

Other

     List any traits you would like to avoid in a dog:

     Is there anything else we should know about what you are looking for in a dog?

     Commitment level (Low/Medium/High)?


     Please provide two unrelated references that we may contact:
         Reference Name 1                Ref. Phone 1
         Reference Name 2                Ref. Phone 2

        Thank you for your application!
A volunteer will be in contact with you within the week.

Street Address:
City:	,	State	,	Zip:
Occupation:
Email:
Additional Email:

Number of Children:		Ages of Children:
Number of Adults:		Ages of Adults:

Housing Situation (House, Apt., Trailer, etc):		Own or rent:
Landlord's Name:		Landlord's Phone Number:

Where will the dog primarily be kept?
Is someone home during the day?
Is someone home at night?
If no to one or both questions, how many hours will the dog be alone?
-----------------------------------------------------------------------------------------------------------------------------------------------------------------
Where is the dog going to stay:
During the Day?		At Night?

What behavior traits or strenghts are you looking for in a dog? (Please indicate with a yes/no)
Playful		Friendly
Obedient		Affectionate
Travels Well		Easy to Train
Good with Children		Does Not Chew
Good with Dogs		Good with Cats
House Trained		Does Not Shed
Good in Crate		Energy Level(Low/Medium/High)
Other