I like dogs that are:

Small

Medium

Large

Any size

The breeds or mixes I like best are:
 
 

 Please describe the temperament and activity level you are looking for in a dog. Check all that apply.

Athletic/high-energy	Outdoor dog	Lap dog
Mellow	Very affectionate	Quiet

When it comes to relating to dogs, I tend to be more:
strict, demanding, a real leader (the dog must sit for a cookie), or

lenient, a little wishy-washy, easily coerced by the dog (the dog looks cute so she/he gets the cookie without performing the sit)

Someone in my home is nervous or unsure of dogs:
very (e.g. bitten as a child)
moderately
some (no experience with dogs)
N/A

About Me and My Household

I share my home with ___ adults and ___ children.
Ages of children:
 
 

I have children that visit or live next door.
Ages:
 
 

 I have ___ indoor cat(s), ___ in/out cat(s), ___ dog(s), and these other pets and livestock:
 
 

 The noise/activity level in my home is usually

low

medium

high

When it comes to keeping a clean and tidy house I am

very particular

particular

easy going

I need a dog that will tolerate being alone ___ hours/day

weekends

for frequent short trips

I'd enjoy brushing or grooming my dog:

rarely

occasionally

weekly

daily

I would enjoy taking my dog in the car:

daily

frequently

once in a while

Exercise

I prefer a dog whose energy level is:

high

medium

low

I prefer a dog that:

will enjoy walking with me on a leash
will enjoy walking with me on or off the leash
will run, jog, or hike with me
will exercise him/herself in our yard
required only enough exercise to do his/her "business"
will enjoy living outside

General

My ideal dog would:
 
 

 Bad doggie habits that I just can't tolerate are:
 
 

 It may take a new pet up to 2 months to adjust to a new home. Are you willing to devote this time?
 
 

 Please tell us anything else you would like us to know about you or the dog you're looking for.
 
 

 Please check any areas you would like to discuss with an adoption counselor:

What to feed your dog and how often	Crate training
Introducing your new dog to other pets	House training
Introducing your new dog to children and other family members	Exercising
Other:

 

 How will you handle the following?

Where will you keep your dog during the day, at night, or when you're not home?
 
 

 If you have to move?
 
 

 How will you care for your pet when you're on vacation or business trips?
 
 

 How will you handle bad habits such as marking, jumping up, nipping, barking, chewing, digging?
 
 

 Please list two personal references:

Name	Address	Phone
Name	Address	Phone

 

 I certify that the information I have given is true, and I authorize CVHS to contact veterinarians, landlords, and references to investigate all statements in this application, and to do follow-up property checks.

Signature

Date

 
 
 

CVHS USE ONLY
Date: ID#	Approved Date:	DNP
Adoption Counselor:	Approved subject to proof of	Date rec'd
Landlord Verification:	ID, age, or address
Property check required	Landlord OK
Vet Report:	For animals at home Spay/Neuter
Description of animal requested:	Current vaccinations

Follow up: (CVHS USE ONLY)