First Name*

Last Name*

Email*

Which animal are you interested in
Choose an animal: Briggs Brody Ernie Foster - Apply to be a Foster Home Newton - ADOPTION PENDING

Have you every applied to adopt an animal from Home At Last Sanctuary, Inc? If so, what was the name of the animal you applied to adopt.

Home Location Type*
Choose one: Rural Suburban Urban

How long have you resided at current location?*

Place of employment (adults only) and how long employed there? Name of Employer? and Number of years with same employer?

Any plans to transfer to another location or change of employment?*

How many hours a day will your dog be left alone?*

Where will your dog be kept while you are not home?*
Choose one: Outside Crated Free to roam house Enclosed Area Basement Other

Please describe when and where you will walk the dog when on leash?*

List ALL places where dog will be allowed to be OFF LEASH:*

How much time do you realistically have each day spend time to directly be involved with your dog? What time(s) during the day will you be directly involved with your dog? What activities will you do while directly involved with your dog? Please give as much detail as possible.*

Who will care for your dog while you are on vacation/travel*

How will you encourage and reinforce appropriate behavior?*

If you have had a dog in the past, did you ever have to deal with any behavioral issues (housebreaking, chewing, separation anxiety)? If so, please list the issue's you have encountered/dealt with? If you have no had any, Answer NONE*

How will you prevent/manage inappropriate behavior?*

Will your dog ever be left outside unattended when you are not home? If yes, explain where.*

What will you do with your dog if you have to move?*

What size dog will appeal to you most when it's fully grown? Either by weight or Small / Medium / Large*

Does anyone in your household have allergies to any animals? If yes, please explain: Please be honest and detailed as possible about; whom has been, or is now allergic to any dog or cat.*

Where will your dog spend the night?*

What would be a reason your would give away your dog. Check All that Apply

If other, or to provide additional information, please explain

Have you had a dog live with you within the last five years?

If you have a dog now, or have had a dog in the last five years; What type of dog? How long did/do you have the dog? OR Answer NO DOG*

If you had a dog where did you get your dog. If you have had no dog answer NO DOG*

Have you ever had to give up a pet for any reason? If yes, what happened to the pet? If never given up a dog answer Never given-up a dog*

If you have a dog or cat now is it spayed or neutered?

Have you ever euthanized a dog? AND/OR Has a dog ever died by accident while in your care? If YES, Please explain. If no, ANSWER NO*

Will you permit a volunteer to come to your home for a Home Visit

Please provide your CURRENT OR PAST Veterinarian's Name AND Phone Number. We do not need to talk to your future Veterinarian.*

Do we have your permission to call your veterinarian *
Choose one: Yes No

List at least three references (who is not a family member) Please provide reference and phone number, and relationship.*

I certify that the information entered on this applicant is true. Enter your NAME and TODAY'S DATE*