Name or ID number of the dog you are interested in

I don't have a specific animal in mind. I'm open to suggestions.

How old are you?

Are you currently a student?

Is anyone who lives in your home allergic to dogs?

Which of the following best describe your home: Townhouse Includes fenced in backyard Own Rent Apartment Stand alone home

If you rent, what is your landlords name and phone number?

If you rent, what breed age and/or size restrictions does your housing have?

My household’s activity level can best be described as: --Select-- Quiet Laid back Middle of the road Busy Chaotic

My experience with dogs is best described as: --Select-- I currently have a dog. As an adult I have had a dog, but I do not have a dog currently. As a child, I grew up with a dog, but I have not owned my own dog as an adult. I have spent time with friends and family members dogs but never owned my own. I have never owned a dog.

I share my home with the following types of animals: None Small dogs (20 lbs or less) Medium dogs (20-59 lbs) Large dogs (60 lbs or more) Cats Other

If currently own pets please list veterinarian name and phone number.

I need a dog that is good with: Adults (Age 18-65) Older Adults (Ages 65+) Children Over 13 Children Under 13 Other animals

If you selected children under 13 please list ages

My dog will be around children: All of the time Frequently A few times a year Never

How often do you have guests visit your home? Visitors include dogs Visitors include children Almost daily A couple times per week A couple times per month A few times per year Almost never

What size dog are you looking for? No preference Small (under 20 lbs) Medium (21-59 lbs) Large (60-99 lbs) Extra Large (100+ lbs)

I want my dog to be: --Select-- a couch potato along for the ride life of the party

It is most important to me that my dog be:

A deal breaker would be:

Are you comfortable adopting a dog with special medical needs? --Select-- Yes No

If you answered yes, please select all that apply. Daily medications Prescription diets Chronic conditions

Are you comfortable adopting a dog with special behavioral needs? --Select-- Yes No

If you answered yes, please describe.

Have you or anyone living in the household ever been convicted of animal cruelty or neglect? --Select-- yes no

*I have read and agree to the Terms and Conditions