Fundraising Campaign – The Puerto Rico Dog Fund

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Length of Time at this Address

Occupation

Phone number

Best time to reach you:

How many adults in your household & relationship to you:

How many children & their ages:

Type of home (single family, condo, apartment, farm etc.) does it have a fenced in yard?

Please describe your household noise/energy level(active, noisy, quiet, etc...)

If you rent, please give the rules governing pets - If renting, proof of landlord approval will be required

How many other pets do you have? Please include type, size and breed.

Are your pets spayed/neutered and up to date on vaccines?

Have you ever surrendered a pet? If so, why? If not, under what conditions would you consider re-homing or surrendering your dog?

Have you ever euthanized your pet? If so, why? Under what conditions would you considering euthanizing your dog?

How do you discipline your pets and why?

What dog are you interested in adopting from the Puerto Rico Dog Fund?

If this dog is no longer available are you still interested in adopting another dog from us, similar type and size?

Please describe where the dog will spend the day.

Please describe where the dog will spend the night..

Number of hours the dog will typically spend alone.

Who will be responsible for the dog's daily care including feeding and exercising?

Do you agree to provide regular health care by a licensed veterinarian?

Do you agree to keep the dog as an indoor dog?

Please provide two references who are familiar with you and your pets. Include their names, relationship to you and their contact info.

The above information is true and complete. The dog will reside in my house as a beloved pet and family member. I will provide the dog with quality food, fresh water, exercise, affection,and annual exams and vaccines by a licensed veterinarian.

Signature and date signed