Registration Form - Pawsitive Results

Phone(Required)

Email(Required)

Best time to call(Required)

Spouse or Roommate's name and telephone number(Required)

Where do you live?(Required)

Parent/Guardian/Landlord's name and telephone number (if applicable)(Required)

Please tell us about each of your cats and/or dogs over the last five years, including current pets.(Required)

Veterinarian's Name(Required)

Veterinarian Mailing Address(Required)

Veterinarian Phone Number(Required)

Who will be the primary caretaker for the dog?(Required)

How would you rate your dog experience(Required)

Why do you want to adopt a dog?(Required)

Is everyone in the house agreeable to getting a new pet?(Required)

Are you willing to attend obedience classes at your own expense (prices range from $80 to $200)?(Required)

Are there children living in your home? If so what are their ages?(Required)

How many adults reside in the home?(Required)

Does anyone in the home have allergies to pets? If yes, who, and how do you plan to deal with this?(Required)

Is anyone in the home afraid of dogs?(Required)

Where will your new pet spend the majority of his/her time?(Required)

Where will your pet be kept during the day?(Required)

Is your yard fenced? how tall, what type of fencing?(Required)

Is anyone at home during the day? when?(Required)

Where will your new pet be kept at night?(Required)

Where will your new pet be kept while you are on vacation, out of town or away from home for an extended period of days?(Required)

How much do you plan to spend on a pet per year?(Required)

Are you willing to make a lifetime commitment which could be 15-18 years for your pet, including medical care, grooming, proper diet, shelter, exercise, companionship, and love?(Required)

What would you do if you had to give this pet up?(Required)

Are you familiar with the use of a crate to train and/or confine a dog in your absence?(Required)

Your ideal dog is (describe)(Required)

Some dogs are lively in the house. They like to play with you and follow you around. Do you think an active dog would annoy you?(Required)

Please describe your dog training experience.(Required)

What type of discipline will you use when training?(Required)

Do all household members understand that it takes time for a pet to adjust to his or her new home?(Required)

Are you willing to put up with some accidents while the dog adjusts to their new home?(Required)

The noise level in my home is best described as:(Required)

Will your new pet be allowed on the furniture?(Required)

Have you ever had behavior problems with previous dog(s)? What did you do to correct the issue?(Required)

What made you decide to adopt this particular dog?(Required)

In the last 6 months, has a dog or puppy died on your premises of distemper, parvo, or unknown causes?(Required)

Would you object to our visiting your home prior to the adoption or as a follow up visit?(Required)

Would you object to our verifying any of the information provided on your application?(Required)

References(Need 3 to be considered) Non-Relative

References 1

Name(Required)

Phone(Required)

References 2

Name(Required)

Phone(Required)

References 3

Name(Required)

Phone(Required)

Phone

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