Please fill out this application truthfully and honestly. Applications are not taken on a first-come-first-serve basis. Any question with an asterisk (*) is required. All dogs will be placed in homes that will best suit them. Applications with false information or incorrect details may take longer to address or be denied. If you are applying from out of state we require vet references and you must come get the dog.

First Name*:

Last Name*:

Email*:

Phone Number*:

Mailing Address*: (Street, City, State, Zip)


I am interested in Fostering:
YesNo

Name, gender, and age of all adults in household: (18yr+, including yourself)*


Age of minors in household: (17 or younger)*


Do you rent or own your current home?*

RentOwn

If renting may we contact your landlord? (If you own, select no)

YesNo

Landlord name and phone number:

Are you open to a home visit?*

YesNo

Name or type of dog you are interested in: *

If you are interested in a specific dog or breed, would you consider a different dog if we feel that
your home is not the perfect fit for the dog you are looking at?

YesNo

Do you have a fenced in yard? (If you do not have a fence this does not disqualify your application.)*

YesNo

How many hours a day would the dog be left alone?*

Please list any animals you currently have in your home: (Name, age, breed, gender, how long you've had them)*


Are the animals in your home spayed or neutered, as well as up to date on vaccines, rabies, flea
protection, and heartworm preventative?*

YesNo

If not, please explain why:


Have you owned any animals in the past?*

YesNo

If yes, please describe them:


Have you ever had a rescue dog before?*

YesNo

If applying for a Shiba Inu, have you owned a Shiba before?

YesNo

If yes, please describe them:

(If not, please take this time to do some research before completing the application to make sure a Shiba Inu is right for you!)


If necessary, are you willing to take your new dog/puppy to obedience classes?*

YesNo

We require that you keep your new dog up to date on dog license, vaccines, rabies, flea protection,
and heartworm prevention. Do you agree to these requirements?*

YesNo

Veterinary Office Information:

Veterinary Phone Number:

The name your records can be found under:

ATTENTION: Please make sure to call your vets office and references to give them permission to speak
with us and to let them know we will be calling!!!

I have read the above statement and will contact my references and vet.

If you do not have a vet please explain why:

Personal Reference 1* (Name, relation, and phone number):


Personal Reference 2* (Name, relation, and phone number):

By submitting this application I understand that if there are any questions left blank it will delay the application process; and that if any of the information provided is false it could cause my application to be denied.