Adopter's Name:

Adopter's Address:

Phone Number:

Your email

What is your age?

Married or single?
—Please choose an option—MarriedSingle
Your occupation:

Do You Rent or Own: —Please choose an option—RentOwn
How long at this address:
1-34-67-9>10
Do you have an in ground swimming pool?YesNo
Is it fenced off?
YesNoN/A
Do you have a fenced yard?
YesNo
Type & height:

Will the dog be an outdoor dog?
YesNo
Have you ever owned a dog?
YesNo
Do you still have it/What happened to it?

Do you own other dogs now?
YesNo
Do you own Cats?
YesNo
Are the existing pets neutered/spayed?
YesNo
Please List Current Pets In The Home:

Your veterinarian's name, address & telephone number:
What form of training will you provide your dog?Obedience classFollow training booksProfessional trainingHome training
How many adults in your household? 1-23-45-6
If you have young children, they need to be educated on how to interact with the dog in order to prevent dog bites, are you able/willing to do that? —Please choose an option—YesNo
Please explain which breed you are interested in and why:
What do you feel makes you a good pet owner?
What types of pet behavior do you find difficult to deal with?
What would you do if your pet developed a physical disability?
What will you do when your pet becomes elderly?
What would you do if your present pets do not get along with your adopted dog?
Do you have any limitations in caring for this particular dog/breed?—Please choose an option—YesNo
Where will you keep this dog when you TRAVEL?
What plans have you made for your pets if you are physically unable to care for them?
What type of balanced nutrition do you intend to provide for your dog?—Please choose an option—WetKibbleWet&KibbleRAW
Are you financially able to provide veterinary care for a dog?—Please choose an option—YesNo
Are you aware of the importance of heartworm preventative?—Please choose an option—YesNo
Would you allow your dog to ride in the back of a pickup truck?—Please choose an option—YesNoMaybe
If adopted, where will your dog sleep at night?
Where will the dog stay during the day?
How many hours per day will your dog spend alone?—Please choose an option—1-23-45-67-89-10>10
Who will provide the necessary care for the dog?
How will this dog fit in with your hobbies/lifestyle, etc.?
Will your dog be crated at home?—Please choose an option—YesNo
Do you wish to adopt a —Please choose an option—MaleFemaleNo Preference
Age preferred:—Please choose an option—Puppy1-23-4SeniorNo Preference
If dissatisfied with your dog, would you return him/her to Etosha Rescue & Adoption Center?—Please choose an option—YesNo
Reference #1:
Reference #2:
Reference #2:
Subject