Name (Last Name, First Name, MI)

Spouse Name (Last Name, First Name, MI)

Home Address

Apt

City

State

Zip Code

Home Phone

(          )

Are You

          (   ) Working         (   ) Retired        (   ) Attending school        (   ) Homemaker        (   ) Other

Employer’s Name

Work Phone

(          )

Spouse Employer’s Name

Work Phone

(          )

Address

Working Hours

Address

Working Hours

e-mail Address

Are there any other adults living in the household?                                      

          (   ) Yes        (   ) No       If you answered yes, list below the other members of the household

Name

Employer’s Name

Address

Work Phone

Working Hours

1.

(          )

2.

(          )

3.

(          )

Maximum number of hours MWD will be left alone daily?

Who will be caretaker for the pet?

(   ) Self   (   ) Spouse   (   ) Children   (   ) Roommate

How many children are at home?

List ages here:

Do you:

(   ) Own   (   ) Rent

Does your landlord/lease or co-op allow pets?

(   ) Yes   (   ) No

Do you have screens on your windows?

(   ) Yes (   ) No

Where will your pet be kept primarily?

(   ) Inside   (   ) Outside

Are you moving?

(   ) Yes   (   ) No        If yes, when?

Are any members of your household allergic to pets?

(   ) Yes   (   ) No

Breed/ M or F

Age

Spay/Neuter

Years Owned?

Do you still have this pet?  If not, where is it?

1.

(   )Yes (   )

(   )  Yes (   )  No

2.

(   )  Yes (   )  No

(   )  Yes (   )  No

3.

(   )  Yes (   )  No

(   )  Yes (   )  No

4.

(   )  Yes (   )  No

(   )  Yes (   )  No

If there are pets living with you, have they been vaccinated?

(   ) Yes   (   ) No          If yes, when?

Veterinarian’s Name

Address

Phone

(          )

Reference Name

Address

City, State, Zip code

Phone

(          )

(          )

Applicant’s Name:

Animal’s Name:                                   Breed:                                    Age:            Sex:

Why are you interested in this dog?

Have you previously owned a dominant dog?

(   ) Yes   (   ) No

What breed types have you owned in the past?

How long did you have the dog(s)?

Where are they now?

Do you intend to use this dog for personal protection or commercial property security?

(   ) Yes   (   ) No

Did the dog(s) ever bite or show aggressive behavior towards you/family members/or any other individuals?

(   ) Yes   (   ) No     If yes, explain what happened:

Have you ever trained a dog before?

(   ) Yes   (   ) No    If yes, what type of training methods did you use?

What type of discipline/corrections would you use with a dog?

If the dog refused to obey a command such as “get off the couch”, explain what you would do to correct this behavior.

If you returned home to find that your dog had chewed your favorite shoes or urinated on the floor what would you do?  Explain what you would do to correct this behavior

If the dog needs professional training, are you willing and financially able to enroll the dog in a group class or with a private trainer?   (   ) Yes   (   ) No

Have you applied to adopt a MWD before?

(   ) Yes   (   ) No         If yes, when?

How did you hear about our adoption service?

(   ) Newspaper   (   ) Internet   (   ) Friend   (   ) TV, what show  (   ) Other _______________________________

Someone in my home is nervous or unsure of dogs…

(   ) Very (ex. bitten as a child)    (   ) Moderately    (   ) Some (no experience with dogs)   (   ) N/A

I have:

(   ) Indoor cat(s)   (   ) In/out cat(s)   (   ) Dog(s)   (   ) Other pets, please list

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

When it comes to pets lying/sleeping on the bed or furniture I:

(   ) Would allow   (   ) Would not allow   (   ) Don’t care

I need a dog that will tolerate being alone _________ hours.

I would enjoy  brushing or grooming my dog:

(   ) Rarely   (   ) Occasionally   (   ) Daily   (   ) Weekly   (   ) Monthly

I would enjoy taking my dog in the car:

(   ) Daily   (   ) Weekly   (   ) Frequently   (   ) Once in a while

I prefer a dog whose energy level is:

(   ) High   (   ) Medium   (   ) Low

I prefer a dog that:

(   ) Will enjoy walking with me on leash

(   ) Will enjoy walking with me on or off leash

(   ) Will run, jog or hike with me

(   ) Will exercise him/herself in our yard

(   ) Requires little exercise

I have or I am planning for:

(   ) A fenced yard   (   ) A dog run    (   ) A stationary tie-out

My ideal dog would:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Bad dog habits I just can’t tolerate:

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

Please tell us anything else you would like us to know about you and why you are interested in adopting a military working dog

____________________________________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

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Initials

I agree to provide reasonable shelter.  (Minimum 5 ft W x 5 ft L x 3 ft H)

I agree to provide a fenced yard to safely contain MWD.  (Minimum 6-foot fence -- 200 sq ft exercise area)

I agree to obtain and provide reasonable medical care.  (Vaccinations, yearly examination, external and internal parasite control)

I agree to notify any veterinary staff that this dog is a former military working dog

I agree to provide adequate food and water

I have been fully briefed on training received by this military working dog

I understand that I need to abide by local animal control, dangerous animals, and licensing laws

I have received a list of critical commands used to control this military working dog’s behavior

I understand I will receive a written summary of this dog’s health

I understand that all military working dogs are neutered/spayed prior to adoption