| First name: | |
| Last name: | |
| Age | |
| Email address: | |
| Co-Applicant: | |
| Address 1: | |
| Address 2: | |
| City: | |
| State: | |
| Zip code: | |
| Phone: | |
| Application to: | |
| Are you applying for a dog already in foster care?
If so, who? | |
| Personal Reference: Name, Phone and Email
address | |
| Personal Reference: Name, Phone and Email
address | |
| Personal Reference: Name, Phone and Email
address | |
| I currently: Rent | |
| If you are currently renting please provide
the name and phone number of your landlord. | |
| I currently: Own | |
| I currently: Live with Family/Friends | |
| I live in a: House | |
| I live in a: Apartment/Condo | |
| I live in a: Mobile Home | |
| How long have you lived at your current residence? | |
| Please describe your yard and surroundings.
Do you have a fenced yard? (what type of fence, size of yard, grass, wooded, etc.) | |
| Please list all animals that are currently
living in the home or have lived in the home in the past 2 years. Please include age, breed, size, spayed/neutered. Does this
animal still live with you, if not, why. | |
| Do you have a regular Veterinarian? If
so, please provide the clinic name, address and phone number | |
| Are you willing to potty train your new
dog? Explain how you will do this or why you would not want to. | |
| By checking this box I agree that the information that
I have provided on this application is true to the best of my knowledge. I authorize PNW Toy Breed Rescue to contact my references,
landlord and veterinarian to obtain any information deemed necessary to decide if I am suitable for adoption | |
| |
