Name of Dog:
*
Your Name:
*
First Name
Last Name
Your Birth Date:
*
MM
DD
YYYY
Spouse/Partner/Roommate Name:
First Name
Last Name
Your Home Address:
*
Tip: This is a system generated form, it has a bug in that it requires the "Address 2" field to be populated with something and not everyone has an Address 2. Please enter a "-" (dash) in Address 2 area if you do not have an Address 2.
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone:
*
(###)
###
####
Email Address
*
Applicant's Place of Employment:
*
Occupation:
*
Applicants Work Hours (Closest to option(s))
*
Applicant other work hours (please describe)
Spouse/Partner’s Place of Employment:
Spouse's/Partner's Occupation:
Spouse/Roomate/Partner Working Hours
S/P/R other work hours (please describe)
Have you ever owned a dog?
*
If yes, do you still have him/her? If not, what happened to him/her?
Have you ever given a dog to a shelter or to someone else?
*
If yes, please explain:
Have you ever had a pet euthanized?
*
If yes, please explain:
Why do you want to adopt a dog/puppy?
*
What will the dog's role be? (check all that apply)
*
Was your last dog obedience trained?
*
Yes, I trained him/her myself.
Yes, I worked with a trainer.
No
I've never had a dog.
Is someone home during the day?
*
Are there any areas of the house where the dog is not allowed?
Do you have a yard?
If yes, how large is your yard?
Describe your yard's fence (check all that apply):
If you don't have a fence, how will you keep your dog on your property?
Do you have a dog door?
*
Will the dog be tied up sometimes?
*
Will the dog spend any time in the garage, basement or cellar?
*
If yes, please explain:
Do you have a pool?
*
If your new dog/puppy is not housebroken, what method will you use to train him/her?
*
Will you keep the dog up-to-date on vaccinations?
*
Will you keep the dog on year-round heartworm prevention?
*
Will you keep the dog on year-round flea and tick prevention, such as Frontline?
*
If you have a pickup truck, where will the dog ride?
*
In the cab.
In a crate in the back.
In the covered back.
In the back.
I don't have a truck.
If you go away for a few days, or on a vacation, who will take care of the dog?
*
What will happen to the dog if you pass away or are hospitalized?
*
Under what circumstances would you give up the dog?
*
What type of behavioral problems would you consider unacceptable?
*
What training methods will you use?
*
What will you do if the dog ruins something you value?
*
Daily Exercise Plan
*
Do you plan on hiring a daily dog walker?
*
Dogs can live 15 years or longer. Can you commit to caring for this pet that long?
*
What will you do with the dog if you have to move or are deployed?
*
What will you do with the dog if you have a baby?
*
Will you get pet insurance? A monthly fee provides added security and coverage for vet bills?
*
If no, please explain:
Are you FINANCIALLY ABLE to spend $1,500 - $5,000+ per year on this dog if required?
*
Are you COMMITTED to spending $1,500 - $5,000+ per year on this dog if required?
*
What type of food will you feed the dog?
*
Is any household member allergic to pets?
*
If yes, how will you deal with reactions to this pet, and work to reduce allergens?
How many adults are in your home?
*
1
2
3
4
5
5+
How many children are in your home?
0
1
2
3
4
5
5+
If you have children in house what are their ages?
How does your spouse/partner feel about adopting this dog?
Will you work out unwanted behavior (chewing, barking, soiling, aggression)?
Yes
No
To an extent.
If no, explain:
Dog Alone Summary:
*
What provisions will you make for the dog should you become unable to care for him/her?
*
How will you deal with any bad habit?
*
On my own
Training classes
Private trainer
Hope the dog grows out of it
Will you be taking your dog to obedience classes?
*
Do you own or rent your home?
*
What kind of housing do you live in?
*
Do you have to use an elevator to get to your unit?
If you rent, what is your landlord's name?
First Name
Last Name
If you rent, what is your landlord's phone number?
(###)
###
####
Personal Reference #1 Name
*
First Name
Last Name
Personal Reference #1 Phone:
*
(###)
###
####
Personal Reference #2 Name:
*
First Name
Last Name
Personal Reference #2 Phone:
(###)
###
####
Current Vet Name, Practice, City:
Current Vet Phone:
(###)
###
####
Name your pet records are under at current vet:
Former Vet Name, Practice, City:
Former Vet Phone:
(###)
###
####
Name your pet records are under at former vet (if different from your own):
Pet #1 Name:
Pet #1 Type:
Dog
Cat
Rodent
Farm animal
Other
Pet #1 Breed:
Pet #1 Gender and Spay/Neuter Status:
Pet #1 Age in Years:
Pet #1 Weight in Pounds:
Is Pet #1 up to dates on vaccinations?
Is Pet #1 licensed?
Pet #2 Name:
Pet #2 Type:
Pet #2 Breed:
Pet #2 Gender and Spay/Neuter Status:
Pet #2 Age in Years:
Pet #2 Weight in Pounds:
Is Pet #2 up to dates on vaccinations?
Is Pet #2 licensed?
Pet #3 Name:
Pet #3 Type:
Pet #3 Breed:
Pet #3 Gender and Spay/Neuter Status:
Pet #3 Age in Years:
Pet #3 Weight in Pounds:
Is Pet #3 up to date on vaccinations?
Is Pet #3 licensed?
If you have additional pets, please list them as you did the others:
Previous Pet #1 Name:
Previous Pet #1 Type:
Previous Pet #1 Breed:
Previous Pet #1 Gender:
Previous Pet #1: What happened to the pet? If the pet passed away, how?
Previous Pet #1 Age Upon Death or Surrender, if applicable:
Previous Pet #1 Date of Death or Surrender, if applicable:
Previous Pet #2 Name:
Previous Pet #2 Type:
Previous Pet #2 Breed:
Previous Pet #2 Gender:
Previous Pet #2: What happened to the pet? If the pet passed away, how?
Previous Pet #2 Age Upon Death or Surrender, if applicable:
Previous Pet #2: Date of Death or Surrender, if applicable:
Previous Pet #3 Name:
Previous Pet #3 Type:
Previous Pet #3 Breed:
Previous Pet #3 Gender:
Previous Pet #3: What happened to the pet? If the pet passed away, how?
Previous Pet #3 Age Upon Death or Surrender, if applicable:
Previous Pet #3: Date of Death or Surrender, if applicable:
How did you hear about OPIN and the dog you're applying for?
*
What kind of dog were you originally searching for? What were your top criteria in choosing a dog?
Are you familiar with local animal control laws?
Any additional comments:
Initials
*
Today's Date:
*
MM
DD
YYYY
