Applicant Information

Applicant Name:   Applicant Age:   Applicant Occupation:
Applicant E-Mail:
Home Phone:   Work Phone:   Cell Phone:
Address:   City:   State:   Zip:
This address is: Apartment/Condo     House     Mobile Home     Townhouse     Other

Will the dog reside at this address?    Yes     No
Do you own or rent your home?     Own     Rent
If renting, how much is your pet deposit?
If renting, please note we will require proof that this pet will be permitted in your residence.

Do you have a fenced yard?   Yes    No
If yes, what type of fence and height? 

How many adults in the household?
How many children in the household?   Ages of children:

Does anyone in your household have allergies to animals?

Who will be the primary caregiver?   Alternate caregiver:
If something should happen to you, who would take responsibility for this animal?

Pet History

Have you ever previously visited with or adopted a dog from Blue Dog Rescue?   Yes   No
If yes, please list name of dog and foster person:

Have you ever moved from one residence to another without taking your pet?   No   Yes
If yes, please explain:

Current Pet Information

Do you currently have pets?   Yes   No
If yes, please provide the following information about each of the animal companions currently in your home:

Pet #1
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you've had him/her:

Pet #2
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you've had him/her:

Pet #3
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you've had him/her:

Pet #4
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you've had him/her:

Past Pets
For each of the animal companions you have had in the past as an adult , please provide the following information:

Past Pet #1
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you had him/her:
What happened to this pet?

Past Pet #2
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you had him/her:
What happened to this pet?

Past Pet #3
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you had him/her:
What happened to this pet?

Past Pet #4
Dog    Cat    Other         Breed/Type:      Spayed/Neutered?  Yes   No
Where did you get this pet?    How long you had him/her:
What happened to this pet?

Specific Dog Adoption Information

Why do you want to adopt a rescue dog?

What interests you in this dog specifically?

Does every member of the household want to adopt this animal?   Yes    No

This dog will stay: Inside only    Outside only     Inside/Outside
Where will the dog be while you are gone during the days? 
Where will the dog sleep at night? 
Do you plan to use a crate with this dog?  Yes    No

Hours per day family is away from home:
Days per year of overnight travel:
Will the dog travel with you?  Always    Sometimes     Never
If not always, where will the dog stay when you are traveling? 

Please list three examples of behaviors that, in your household, would result in a correction for the dog:

How do you plan to correct the dog if he/she does something wrong?

Excluding emergency care, please estimate what you expect to spend annually on food, routine vet care, heartworm/flea prevention, toys, treats, bedding, training, and equipment for this dog:
under $100     $100-$500     $500-$1000     $1000-$2000     over $2000

I plan to engage in the following activities with this dog on a daily basis: (check all that apply)
Walking/Hiking     Running     Playing Fetch     Yard Work     Dog Park     Car Rides     Dog Day Care     Watching TV     Obedience Training

I plan to engage in the following activities with this dog on a weekly basis: (check all that apply)
Walking/Hiking     Running     Playing Fetch     Yard Work     Dog Park     Car Rides     Dog Day Care     Watching TV     Obedience Training

Are you familiar with heartworm prevention?  Yes   No

Vet/Home Visit Information

What is your veterinarian’s name?      Clinic Name:
Please type your initials here to indicate your consent for a
Blue Dog representative to verify current/past pet information with your veterinarian:

Would you object to a home visit by one of our representatives? No   Yes

How did you hear about Blue Dog?