Name of Dog

Date of Birth

Address (include city & zip)

E-mail

Phone

Why do you want to adopt this particular dog?

What personality traits or behaviors are important to you/your family?

Do any members of your immediate family have allergies to animals? If yes, please explain.

On average, how many hours a day are you away from home?

Have you owned a pet before? Please specify.

Have you adopted from a rescue organization before? If so, which one and what year?

Have you purchased from a breeder or pet store before?

Do you want your pet spayed/neutered?

Have any of your current pets had medical issues within the past 12 months? If yes, please specify.

Have any of your current pets had behavioral issues within the past 12 months? If yes, please specify.

Where will your pet spend most of its time? (inside/outside, etc.)

Is your home owned or rented? If rented, please see next question.

For rented homes and apartments, please provide your landlord's name and number. Are you able to provide written permission from your landlord and proof of a pet deposit before taking possession of the dog?

How long have you lived at your current address?

Do you plan on moving soon?

Do you have a fenced yard? If so, what type of fence and height?

What is the number of pets living in your home? What types/breeds and ages?

Are your pets current on vaccines? If not, please specify.

Do all of your pets take monthly heartworm prevention? If not, please specify.

Are all of your pets spayed/neutered? If not, please explain.

When will your pet be inside/outside?

Do you currently have a vet? What is the name and number of the clinic? Please call ahead of time and give permission for us to speak with them.

Is there any other information you would like to share with us?

Please list 2 references with name, number and relationship to you.

How did you hear about Emma's Wish Senior Dog Rescue?