Adoption Application Rescue and save a life Ready to Apply? Please fill out an application and we will get back to you as soon as possible. If you have any questions, please feel free to email us or message us on Facebook. Step 1 of 7 14% Basic InfoName* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone*Email* Is there another person responsible for the dog's care?* Yes No Name Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Housing InfoAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many years have you lived at your current residence?*Less than 11 to 33 to 55 to 1010+Previous Address* City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you own or rent?*OwnRentLandlord Name* First Last Landlord Email* Landlord Phone*Type of housing*Single-Family HomeApartment high-riseApartment low-riseCondoTown-houseMobileOtherAre you moving in the near future?*YesNoN/AWhat is your future address?* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please list all people and age who reside in home over 18*Please list all minors (under 18) and age who reside in home*Please list the ages and genders of regular visitors to the home*Are all persons in household on board to adopt a dog?*YesNoN/ADoes anyone in the home have any known allergies?* Yard DetailsDo you have a backyard?*YesNoSize of Backyard* Do you have a front yard?*YesNoSize of front yard* Do you have a fence?*Yes, BothYes, Just in the backyardYes, Just in the front yardN/APlease provide details of the fencing typeType of Fence (e.g. Wood slate privacy fence, Chain link fence, Picket fence)Height (in ft)3 feet4 feet5 feet6+ feetN/AIs fence secure on all sides of yard?YesNoN/ASince your fence is not secure, Please explain Vet ReferencesName of Veterinary Practice Veterinary PhoneVeterinary Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal References#1 – Personal Reference Name* First Last (non-family member)Personal Reference Phone*Personal Reference Email Relationship to Reference* #2 – Personal Reference Name* First Last (non-family member)Personal Reference Phone*Personal Reference Email Relationship to Reference* Information About PetsWhich ASCZ Dog are you interested in?* Is this your first dog?*YesNoDo you currently own one or more dogs?*YesNoPlease provide the breed, age, gender, a brief description of personality of current dog(s), and where obtained*How does your current dog(s) act towards visiting dogs (if known)?*Have you owned dogs in the past 10 years?*YesNoPlease provide any helpful information about past dog ownership prior to current dogs if applicable.Do you have any specific dog training experience? (Check All That Apply) House-Breaking Leash Skills Crate-training Special Needs Experience Leash Reactivity Timid Behavior Blind Deaf Hospice Other training experience?Do you own one or more cats?*YesNoPlease provide age, gender, and personality of your cat(s)*Please provide information explaining how your cat(s) act towards visiting dogs (if known)?*Do you have any other animals (e.g. birds, reptiles, fish, hamsters, guinea pigs, rabbits etc.)?*YesNoPlease list your other animals*Is there any livestock on your property? If yes, please list* Final DetailsSize* 5 – 35 lbs 35 – 55 lbs 55 to 85 lbs 85 lbs+ Check all that applyAge* puppy 3 to 5 months 5 months to 1 year 1 to 4 years 5 to 8 years 8 years + Check all that applyGender* Male Female Housebroken* Yes No Energy Level* Low Medium High Are you ready to adopt now?*YesNoSince you selected no, when will you be ready?* MM slash DD slash YYYY How many hours per day will the dog spend alone?* Where will the dog be kept at night? (check all that apply)* Free roaming inside Gated off area inside Crate Garage Outside Other Since you selected "other" please explain* Where will the dog be kept at day? (check all that apply)* Free roaming inside Gated off area inside Crate Garage Outside Other Since you selected "other" please explain* How did you hear about us?* Facebook Twitter Petfinder.com AdopAPet.com AllPaws.com Other Social Networks Google Bing Yahoo A Friend Other I understand the adoption fee for dogs 6 months and older is $450.* I agreeI understand the adoption fee for dogs under 6 months is $550.* I agreeI understand that my application will be reviewed as quickly as possible. An adoption coordinator will contact me with more information via email or phone within 72 hours.* I agree How Can You Help? we can do it together Contact Us