First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

If you listed a cell phone, is it okay if we text message regarding this request?"

What is your occupation?*

Which dog are you applying for?*
Choose an animal: Archie Belinda Carlisle Ben Bernie Bootsie Colby Benson Dice Hopper Jax (Kieran) JT Jupiter Khabibi & Berti *CL* Leia Letty Lil Nugget Linny *CL* Louie Lucy G Mack Mater *CL* Mena Odin Olive Benson Padme Peaches Pepper Pippy aka Pipsqueak Popcorn Rascal Raven Weaver Rickie Sabrina Sassy Pants Searcy Shadow Sky Tally Thomas Brambila Thompson *CL* Toby Schudy Tucker *CL* Weston

What is your second choice, if any?
Choose an animal: Archie Belinda Carlisle Ben Bernie Bootsie Colby Benson Dice Hopper Jax (Kieran) JT Jupiter Khabibi & Berti *CL* Leia Letty Lil Nugget Linny *CL* Louie Lucy G Mack Mater *CL* Mena Odin Olive Benson Padme Peaches Pepper Pippy aka Pipsqueak Popcorn Rascal Raven Weaver Rickie Sabrina Sassy Pants Searcy Shadow Sky Tally Thomas Brambila Thompson *CL* Toby Schudy Tucker *CL* Weston

What traits are you looking for in a dog?*

Is this dog a gift? If yes, who is the dog for?*

Have you or any family member ever adopted or applied to adopt from us or another rescue group or shelter? *

If yes, which group did you apply with and did you end up adopting an animal?

Please list any pets you have had in the past 10 years. Please list their name, age, breed, sex, and if they are/were spayed or neutered.*

Do these pets currently reside in your home? If no, where are they now (i.e. deceased, in a different home, lost, gave up to rescue group/shelter, etc.)

If you have pets that currently reside in your home, what are their living conditions? For example, where do they stay during the day and at night?

Please provide the name AND PHONE NUMBER of your current (or previous if you've had animals in the last 10 years) veterinarian.*

If you do not have an established veterinarian, please provide the name and contact information for 2 personal references.

How long have you been at your current residence?*

If you have been at your current address less than a year please list your previous address.

In what type of home do you live

Do you own or rent your home

If you rent, please enter your landlord's name AND PHONE NUMBER

Are there any restrictions on breeds, weights, or number of pets allowed? If so, please detail what they are.

Is there a pet deposit and if so, has it been paid?

Please list the names (First and Last) and ages of everyone in your household.*

Who in the household will care for this dog*

Is your yard fenced

What type and height of fence do you have? (check all that apply)

How do you plan to exercise your dog?*

Will this dog be kept:

How many hours per day will this dog be alone?*

Where will this dog be kept when you are not home*

Where will this dog be kept when you are home*

Where will this dog sleep?*

How do you plan to train and discipline your dog?*

What do you consider to be normal medical care for your dog? What is required monthly and yearly?*

What do you know about heartworms and heartworm prevention?*

Have you ever given up a pet? If yes, please explain the circumstances and what happened to the pet.*

If you move, what will you do with your dog?*

What circumstances would cause you to give up this dog?*

Please remember that a pet is a lifetime responsibility…its lifetime. What arrangements have you made for your pet if something should happen to you?*

All applicants are subject to a home visit prior to adopting an animal. Are you agreeable to a home visit from a TARA representative?

How did you hear about us? *Required

If "friend/relative" or "other", please explain:

Comments/Additional Information