Date
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MM
DD
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Name
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First Name
Last Name
Email
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
MM
DD
YYYY
Home phone
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(###)
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Cell phone
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(###)
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List your occupation, employer, years at address. If unemployed or a student, detail how you plan to provide for a dog
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How many people are in your household? List their ages.
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How many children live in your household? What are their ages?
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Do you live in a house, apartment, condo, townhome, duplex?
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How long have you been at this address?
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Do you own or rent your home?
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If renting, are there any pet restrictions?
If yes, what are they?
Have you or anyone in your home ever been charged or convicted of animal abuse, cruelty, or neglect?
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Have the police ever been called to your residence for domestic violence?
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Do you currently have pets?
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If yes, what kind?
Please check all that apply
How long have you had each current pet?
Are they spayed/neutered?
If spayed/neutered, which veterinarian do you currently use?
Do you have a yard?
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If yes, is it fenced?
What is the height of fence?
Fence material? (wood, chain link, brick, other)
If you do not have a fenced yard, do you agree to keep your dog on leash at all times when outside?
Who will have primary responsibility for this dog's daily care?
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Who will have financial responsibility for this dog?
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Do you agree to provide regular health care by a licensed veterinarian?
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How will you discipline your dog?
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If behavioral issues arise, are you willing to work with a professional trainer?
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Dogs need preparation training for life changes such as having a baby, moving, divorce, etc. Are you committed to working through these changes?
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How much quality time can you offer your dog, and what type?
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What breeds do you have experience with?
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How many hours during the day will the dog spend without a human?
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Which hours of the day on a normal day will the dog be walked, and who will be responsible?
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Where will the dog be when someone is home?
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Where will the dog be when alone?
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Where will the dog sleep?
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How would you describe your level of experience with dogs?
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Please check all that apply
What size dogs do you have experience with?
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Please check all that apply
What situations do you feel unprepared for?
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Check all that apply
Is there a specific Zion's Mission dog that you are interested in?
Please tell us anything else you'd like us to know.
Please list two references.
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Include name, address, phone number
