First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Please list the name, age and relationship of all people in your household:*

Street Address*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Do you own dogs or cats? Please provide the name and age of each:*

If not spayed or neutered, what are the circumstances?*

Where will the animal sleep*

Describe how you will train the pet*

What traits are you looking for in a pet

Have you ever given up a pet? If yes, please explain*

List at least one reference (who is not a family member)*

Veterinarian's Name, Address and Phone Number: by submitting this application you give DDR permission to retrieve information from your veterianarian. Please call your vet and tell them to release the information we need when the DDR representative calls. We cannot process applications without the information from your vet.*

Why are you interested in adopting a pet at this time?*

Which animal are you interested in?*
Choose an animal: Ada Afraid of Commitment Baker Carmel Dash Erin Gaston Get pre-approved Hershey Ivy Jenna Jet JJ Joey Jordi Mya Oreo Patrick Prince Punch Rory Sam Elliott Smokey Yogi

I certify that the information entered on this application is true and correct.. Enter your full name and date.*

Have you applied with any other rescue?

How did you hear about us?*

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*
Choose one: Rent Own

Who in the household will care for the pet?*

How many people reside in your household?*

If you rent, have you received the approval of your landlord to have an animal?*
Choose one: Yes No

If you rent, please enter your landlord's name and phone number*