Career Change Adoption Application

Name *
Name
Date of Birth
Date of Birth
Phone *
Phone
Address *
Address
Do you rent or own your home?
Do you have a fenced yard?
Do you work?
What is your work schedule?
Are there other people living in your household?
Do you have children residing in your home?
Does anyone in the family have a known allergy to dogs?
Is everyone in agreement with the decision to adopt a dog?
Do you have time to provide adequate love and attention?
Do you have animals in your home?
Have you ever surrendered a pet?
Desired Gender
Willing to adopt *
Please list an individual that is familiar with you, your family and your pets that we may contact as a reference
Name *
Name
Phone *
Phone
If selected to receive a TLCAD career change dog, do you agree to provide quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed veterinarian?