Adopt – Creegan Canine Rescue

Name *

First

Middle

Last

Date of Birth *

Other People Living in Your Home? *

Spouse / Significant Other Living in Home / Roommate:

First

Middle

Last

Spouse/ Significant Other Living in Home / Roommate Date of Birth

Address (Line 1) *

Address (Line 2)

City *

State *

Zip Code *

Primary Phone Number *

Secondary Phone Number *

Email *

Occupation *

Hours Per Day Dog Would be Left Unattended (For School, Work, Errands Etc) *

Spouse/ Significant Other / Roommate's Occupation

Has anyone in your household ever been convicted of a violent crime or animal abuse crime? *

Will you submit to a home inspection and background check? *

Yes
No

Type of Residence *

Fenced Yard? *

Own or Rent? *

If renting, can you obtain written permission from the homeowner to own a dog? *

If renting, please provide homeowner's name and/or Property Management Company Info

If renting, please provide homeowner's and/or Property Manager's phone number

Age / gender of children / other adults living in your household not already entered above (if none, enter N/A) *

Age / gender of children who frequently visit your home? (if none, enter N/A) *

Other pets in the home: *

Dogs
Cats
Other
None

Physical Description of all other animals in your home (species, breed, size, temperament, health concerns, special needs, etc)

Are your others dogs/cats spayed/neutered? *

Are you financially prepaired to pay for annual and emergency vet visits, food, treats, toys, boarding when traveling, and preventative care for vaccinations, flea, tick, and heartworm monthly preventatives? *

Name of your current veterinarian or vet you will use for your pet: *

Phone Number of veterinarian you use / will use: *

Current Groomer / Future Groomer's Name: (if none, enter N/A) *

Current Groomer / Future Groomer's Phone: (if none, enter N/A) *

How often would you have your new dog groomed? *

Tell us a little about why you would like a dog: *

Have you ever owned a dog before? If so, and you no longer own them, please explain: *

What dog are you interested in? ( If not a specific dog, please describe a preferred sex, age, breed, etc) *

How did you hear about us? *

Would you have an interest in volunteering / fostering with us? *

When would you be ready to adopt? *

Please provide the name and phone numbers of 1 personal references and their relationship to you: *