Dog Name ____________
Counselor ____________

Thank you for filling out this profile.
The information you provide will help us help you find the best match for you and your family.

Name _______________________    Driver's License # ___________________
Street address __________________ City_______________ State ___   Zip ______                                       Home Phone ______________  Work Phone ____________    Cell Phone______________                                                                                      Place of employment____________________ How long________                                                                    Previous place of employment_________________   How long were you at that job?______
Names of others in household (include ages)_______________________________________________ ______________________________________________________________________________
Length of time at address _______ r Own    r Rent   r Live with parents   r Military
Housing type:      r House     r Condo      r Apartment      r Mobile home
Landlord name _____________________ Landlord phone __________Previous Landlord___________
Please list your current veterinarian _____________________ Vet Phone Number__________________                                            How did you hear about our adoption program? ____________________________________________

Current Pets

You & Your Household

Your Ideal Dog

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long have you owned this pet? _____________________

1. Dog Experience
r First Time Owner
r Have had one or two
r Knowledgeable & Experienced

How did you get your knowledge? _____________________________

Breed Type/Mix
_____________

Adult Size
r 0-20 lbs. Small
r 20-50 lbs. Medium
r 50-100 lbs. Large
r Over 100 lbs. Giant

Coat
r Shortr Medium
r Long r No Preference

Age
r 8-16 weeks
r 4-12 months
r 1-3 years r Older r No Preference

Training
r None
r Housebroken
r Some obedience training
r Fully trained

Activity Level
r Low r Mediumr High

Sex
r Maler Female
r No preference

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long have you owned this pet? _____________________

2. Time Away From Home
r Home all day
r Out part-time
r Away 7-10 hours daily

Is this likely to change? _______

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long have you owned this pet? _____________________

3. Our Dog Will Live:
r Indoors only
r Indoors/Outdoors
r Outdoors only

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long have you owned this pet? _____________________

How often do you take your pet to the vet?__________________

Who is the pet’s primary caregiver?________________

When you go on vacation, who cares for your pets?___________

4. Home Atmosphere
r Grand Central Station
r Some activity
r Zen-garden serene

Describe your pet’s play area______________________

What is the diet that you plan for this animal?________________

What behaviors are you unwilling to deal with?__________________

Feel free to add additional comments on the last page!

Past Pet History

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long did you own this pet? _____________________

Why do you not have the pet anymore?

___________________________

What other types of dogs are in your neighborhood?

How do you show your dog you are Alpha?

If your dog ever becomes aggressive, what will you do?

What are some signs that your dog is trying to be in charge?

Why is obedience training necessary?

Do you know what crate training is? What is your opinion of it?

What is the best personality for your dog?

I understand that the animal and its conditions may be checked on at any time. I also understand that if conditions are not suitable that the animal will be taken back into Mama Dori’s Jungle custody. _______ (Initial here)

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long did you own this pet? _____________________

Why do you not have the pet anymore?

___________________________

Type ________________
Name _______________
Age ________ Sex _____
Spayed/Neutered r Yes r No
Kept r Inside r Outside r Both
How long did you own this pet? _____________________

Why do you not have the pet anymore?

___________________________

Describe your dog’s sleep area?

_________________________________________

I give Mama Dori’s Jungle rescue permission to do criminal background checks as well as checking with unnamed authorities to see if I or anyone who will be around this dog has been involved in suspicious activity or charges that may affect the well-being of said dog. _____________________________(Typing your name into this area is considered a validated signature.)

Signature____________________________________

(The signature here verifies that all information on this application is true.)

Date:_____________________

Witness:_______________________________

Date:________________________

ADDITIONAL COMMENTS FROM POTENTIAL ADOPTER(S):____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Staff Comments- Do not write below this lineOf

Date Called

Animal's Name

This area is for the screener to make notes. Do not write below this line.

Guideline Exceptions:

Date ______ Counselor Initials ______ Approved ________ Denied/Priors Made ______
Pending Landlord Approval (date) _____ Applicant Informed ___
Pending Family Approval (date) ______Check Impound File ____

Please send a copy of this application to kll8254@hotmail.com

Snail mail is not recommended when observing our policy of adopting with fairness. The first approved application with the adoption fee paid gets the dog. We want to be fair to everyone.