Name
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First Name
Last Name
Email
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Home Phone
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(###)
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Cell Phone
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(###)
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Address
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Home Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Name of dog you you are interested in, and indicate whether you want to adopt or foster.
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Do you rent or own your home
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If you own your home, does your insurance cover dogs?
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Do you live in a...
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How long have you lived at your current address?
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If recently moved, how long at your last residence?
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What is your occupation?
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Name and phone number of Contact Person who can always reach you
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How did you hear about Lizzy's?
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Does everyone in the household want a dog?
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Do any family members have a handicap or mobility issue we should to be aware of?
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Number of adults in your household
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Number and ages of children in your household
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Do you have a fenced yard?
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Is there anyone at home who might be allergic to dogs?
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List current pets, including age and sex
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Tell us about the past 2 or 3 pets (dogs, cats, etc. fish excluded) and why they no longer have them.
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Are all your pets spayed or neutered ?
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Have any of your pets had offspring?
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Veterinarian’s Name and phone number
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Do you currently use this vet?
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List three references with phone numbers- at least one should not be a family member
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Who will be responsible for dog's care?
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Where will dog be during the day?
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Where will dog be at night?
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Are you familiar with using a crate to train and/or confine dog?
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Do you own a crate?
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Will dog have run of the house?
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Will dog be tied outside or live in the yard?
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How will you discipline dog?
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How will you exercise dog and what activities will you share?
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What will you do with dog when you go on vacation?
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If you move, what will you do with dog?
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Are you willing to take responsibility for dog for 10 years or more?
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Are you aware of the cost of caring for a dog or older dog each year (vet care, licensing, food, toys, training, elder care, etc. minimum $500)?
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What heartworm preventative will you use?
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What steps will you take to control fleas?
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If you are unable to care for dog, who will accept responsibility for dog’s care?
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What type of vehicle will you transport dog in? If truck, where will dog be in the truck?
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I will follow up on the dog – would you mind a visit or call?
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Why do you want a dog?
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Please explain your idea of dog that would best fit in your home, including age and temperament:
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Add any additional comments here
