Dog(s) you are
applying for:
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Your name: |
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Address (include city,
state and zip code):
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Telephone
(work and home), include area
code: |
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Email address (Required): | |
Name and Phone Number of
person who can always reach you who does not live at the above
address: |
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Where do you live? |
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Do you own or rent? | |
How long have you lived at
this address? | |
List all human members of household
including ages of children: | |
Does any member
of your household have any known allergies to animals? |
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If yes, please describe: | |
Do we have permission to visit your home? | |
If no, why not?
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Pet History | |
Do you currently have any other pets? |
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If yes, please describe (include all animals including roommates' animals), type,
age, sex, spayed/neutered, kept indoors or outdoors, had how long? |
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Your veterinarian's name and
telephone number:
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List pets owned in the past 10 years, other than those listed above. Include type, age, sex, spayed/neutered, kept indoors
or outdoors, had how long, when you stopped owning the animals and reason: |
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Have you ever brought an animal to the shelter?
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If yes, what were the circumstances? | |
Do you
anticipate moving soon? | |
If yes, when? |
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Dog-Specific
Questions |
Please state reason for wanting a dog as a companion: | |
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If you have any preferences as to breed type, gender, age, size, length of hair, what are they? |
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I need a dog that gets along with: |
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I need a dog that is good with: |
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I want my dog to be by my side when I am home: |
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I want my dog to be the type that is very enthusiastic in the way it shows affection. |
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When it comes to a dog lying on the furniture I would: |
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When it comes to a dog sleeping on the bed I would: |
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I want my dog to be playful: |
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I would like my dog to participate in what hobbies or activities with me: |
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I prefer a dog whose energy level is: |
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What else are you looking for in a dog that you would like us to know? |
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Do you have a fenced yard? If so, how high is it, what is it made of, what kind of gates
are there, and what size is the yard? |
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Is your home usually quiet,
has some activities and visitors, or are people come and going all
the time? |
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How much time per day will you
be able to interact with your dog? | |
If you suddenly
relocated or had other drastic lifestyle changes that made it hard to keep
your dog, what would you do with him/her? |
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Who will care for
your dog when you go out of town, or in case of an
emergency? |
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If your dog becomes seriously
ill or injured and your veterinarian says expensive medical treatment is
needed, what will you do?
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Do you plan to have your dog spayed or neutered? Why or why
not? |
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Have you ever
lost a pet? What did you do to find him/her? |
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To provide food
and medical care for this dog, I anticipate spending
yearly: |
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Where will the dog be kept while
you are away? |
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Where will the dog sleep at
night? |
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How will you keep this dog confined to your
property? |
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You may have to housetrain
your new dog. Have you done this before, and how long do you
expect it to take? |
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Have you ever completed an
obedience class with your current or previous dogs? Do you
plan on taking the new dog to obedience training? If so,
where? |
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What will you do if the dog
chews furniture or demonstrates other destructive behavior? |
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Are you familiar with
heartworm disease? |
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Are you familiar with leash
and licensing laws in your community? |
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What kind of diet will you provide for your
dog? What kind of food (wet or dry), what brand, what kinds of treats? |
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Are you committed to taking
full responsibility for your dog's health and welfare for the rest of
its life, which could be 10 years or more? |
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I certify that I am 18 years of age or older
and that I live within driving distance of Austin, Texas. Please click
Submit when you are done.
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