Name of dog you are interested in
Name
*
First Name
Last Name
Spouse's Name (or partner)
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Number of years at this address
*
Phone
*
(###)
###
####
Email
*
Prior Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date Of Birth
*
MM
DD
YYYY
Maritial Status
*
Do you have children under than age of 19
*
List the name of children and Age under the age of 19
Occupation
*
Spouse's Occupation (or Partner)
Do you or your spouse anticipate being deployed overseas?
*
Have your children lived with or had exposure to dogs?
*
Do you own or rent your home?
*
Is it a house, condo, townhome, or apartment?
*
Fence yard?
*
Fence height
Fence fully enclosed
If renting, landlords name
If renting, landlord's phone
(###)
###
####
Do you live with roommates?
*
List all roommates and phone numbers if applicable
List all pets and include species, breed, gender, age, and any medical issues.
Are all pets spay and/or neutered?
If No, please list reasons
Are all pets Up-to-date on vaccinations
If No, please list reasons
What do you feed your dog(s)?
How many times per day do you feed your dog(s)?
How long are your dog(s) left alone during the day?
Where do your dog(s) stay when you're not home?
How do you exercise your dog(s)?
Where do your dog(s) sleep at night?
Do you crate your dog(s)?
Do you plan on crating this dog?
What is your favorite thing to do with your dog?
What is your least favorite thing your dog does?
List any pets you've owned in the past 6 years but no longer have (include their breed, name and age) and why you don't have them any longer.
Were there any behavior problems?
Veterinarian Name
Clinic Name
Veterinarian's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Veterinarian's Phone
(###)
###
####
Length of time you have known the Veterinarian
Reference #1 (non-related) Name
*
Reference #1 Phone
*
(###)
###
####
How long have you known reference #1?
*
Relationship to reference #1
*
Reference #2 (non-related) Name
*
Reference #2 Phone
*
(###)
###
####
How long have you known reference #2?
*
Relationship to reference #2
*
What research have you done concerning owning a dog?
*
Why do you want to rescue?
*
How much do you think it will cost to feed a dog per month?
*
Are you financially capable to cover medical cost for the dog, including updating vaccines?
*
Are you willing to attend obedience classes?
*
Will you agree to only use a Gentle Leader, an Easy Walk Harness, or plain collars when leash walking?
*
What traits are most important to you in finding a new dog?
*
How would you explain your family's activity level?
*
Where will your new dog sleep at night?
*
Are you interested in adopting a senior or special needs dog?
*
Are you interested in becoming a volunteer for One Dog at a Time?
*
Are you interested in becoming a foster home for One Dog at a Time?
*
Additional information you want One Dog at a Time to know
How did you hear about One Dog at a Time
Agreement
*
