Adoption Application

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.

First Name*:

Last Name*:

Email*:

Phone Number*:

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


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.