First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone

Text/Pager Email

What is the name of the dog you are interested in?*
Choose an animal: Ark Balton Blitz Doby Elle Mae Elvis Hyde Luna Madison Marley Starlight

We require a $100 deposit on all applications being processed (we will inform you when to make the deposit) The $100 deposit will go towards the adoption fee when adoption is finalized.* *

Employer and hours you work?*

Spouses/Partners Employment and Employment Hours*

Ages of everyone in the home including yourself.*

How many hours would the pet be alone?*

Where would the pet stay while you were at work or away from home for few hours?*

How will you deal with the dogs elimination needs when you are not at home?*

Where will the dog sleep?*

Where will your dog go while your traveling?*

What will you do with your pet if you have to move?*

Are you willing or able to purchase a crate if advised to?

We require our dogs attend training classes as part of our adoption contract. Are you willing to take your pet to obedience class ?

What is the term Socializing? *

How will the dog be getting exercise?*

Is everyone in the house in agreement for this particular dog?

Is there anyone in the house with allergies? *

Are you a member of the Homeowners association? If yes do you have a copy of all the bylaws, policies, regulations, etc. especially as they relate to pet ownership? *

Do you Own or Rent your home or apartment? If renting how long at location? If renting, does your lease allow pets? Breed or weight restrictions? Pet deposit required? (We will need confirmation of payment of any required pet deposit.) PLEASE PROVIDE LANDLORD CONTACT INFO*

Do you have a fenced yard? What type of fence and how high? Are gates securely locked? If "No" are you willing to do so?*

Do you have a pool? If "yes" is it fenced off?*

Have you ever adopted from a rescue group or shelter? If so, what group/shelter? *

What qualities are you looking for in a pet? (Please be specific) What traits or characteristics are you NOT willing to work with? *

Please List Two references: (Name & Phone) Please Provide VET name and number : (Please contact your vet after filling out this form to let them know someone from Wags & Wiggles Rescue will be contacting them for reference check)*

Please LIST any CURRENT and/or PREVIOUS DOGS, CATS or OTHER PETS. Please include BREED, SEX & AGE. Did they have any health, behavioral issues? If you no longer have, what happened to pet? *

Have you ever given up a pet? Have you had an animal hit buy a car? if so, what were the circumstances? Have you had an animal that was lost or stolen? *

Is there anything you'd like to add? *