1. Do you CURRENTLY own any pets? Yes / No If YES, please list:
Name: Type (species and breed): Age: Length of Ownership:

2. a. If you own dogs or cats NOW, are they all spayed/neutered? Yes / No If NO, why not?
b. If you own dogs NOW, are they on heartworm preventative? Yes / No If YES, what type? If NO, why not?

3. Have you owned pets in the PAST that are no longer with you? Yes / No If YES, please list:
Name: Type (species and breed): Age: Where is this animal now?

4. Where do you live? House ___ Apartment/Condo___ Mobile Home ___ Other:__________

5. Do you own or rent your home? Own ____ Rent ____
If you RENT, does your landlord or association permit you to keep a dog? Yes / No
Please provide your landlords name and telephone #:

6. Does your home have a yard with a fence? Yes / No

7. Do you have a crate to keep the dog in? Yes / No

8. What is the longest period of time that the dog would be left unattended?

9. a. Where will you keep the dog while you are at work or out on errands?
b. Where will you keep the dog while you are on vacation?

10. Will the dog be allowed on furniture? Yes / No

11. Where will the dog sleep at night?

12. Does any one in the household suffer from allergies or asthma? Yes / No

13. Why are you interested in adopting this breed or particular dog?

14. Do you have a preference for sex, color or age bracket? If so, what is it?

15. How many people (adult & children) reside in the home?
Please identify all members below:
Name: Gender: Age:

16. Please provide us with a veterinary reference (including phone number):

17. Please provide us with a personal reference (including phone number) :

18. Do you agree to a Canine Castaways representative and possibly a foster dog visiting your home prior to and/or after adoption? Yes / No

19. Are you willing to enroll the dog in obedience class or other training if you experience behavior problems? Yes / No

20. Do you understand that the dog should never be allowed off leash in open places? Yes / No

21. Have you ever owned a rescued animal? Yes / No

22. Do you understand all of the expenses involved with caring for a dog, especially as it ages? Including but not limited to ordinary & emergency veterinary expenses, heartworm preventative, dental care, grooming, etc. Yes / No

23. All of our dogs are spayed/neutered, vet-checked, up to date with shots and evaluated before they are placed. Our adoption donation which ranges from $150 to $250 helps with these expenses. Do you understand the need for this donation and the fact that all donations are NON-REFUNDABLE after 14 calendar days? Yes / No

24. Do you understand that there are no guarantees about the house training, behaviors, temperament or health of a dog that is adopted and that the adjustment period varies for each dog? Yes / No

25. Have you applied with another rescue organization in your search for your new family member? It helps us to realize this when trying to coordinate our volunteer efforts.
0 I have an application currently submitted with another rescue.
0 I applied with another rescue but did not adopt from that organization.
0 I have never applied with another rescue organization.
0 I adopted through another rescue organization in the past.