Below are three areas for information on other members of your family. Please include all other adults , children and pets living in your home by clicking on the designated button.
Adults Are There Other Adults In The Home? How Many?* Select Option 1 2 3 4
Adult 1 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are They in College?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 2 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are They in College?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 3 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are They in College?* Full or Part Time?* Full/Part? Full Time Part Time
Adult 4 First Name*
Last Name*
Age Range* Select Age Range Age: 18-21 Age: 22-24 Age: 25-34 Age: 35-44 Age: 45-54 Age: 55-64 Age: 65-69 Age: 70-74 Age: 75+
Gender* Select Gender Male Female Non-Binary Prefer Not To Answer
Relationship To Applicant* Select Relationship Spouse Significant Other Roommate Parent Other Family Member Other
Please Describe*
Phone Number*
eMail Address*
Are They Employed?* Full or Part Time?* Full/Part? Full Time Part Time
Name of Employer*
How Long Employed There?* Select Timeframe Under 1 Year 1-2 years 3-5 Years 6-10 Years 11-20 Years 21+ Years
Are They in College?* Full or Part Time?* Full/Part? Full Time Part Time
Children Are There Children In The Home?* How Many?* Select Option 1 2 3 4
Child 1 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 2 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 3 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Child 4 Name*
Age* Select Age Under 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Gender* Select Gender Female Male Non-Binary Prefer Not To Answer
Previous Experience with Dogs:* Select Experience Level Not Experienced At All Limited Experience Around Dogs A Lot Has Had or Currently Has A Dog
Dogs Do You Currently Own a Dog?* How Many?* Select Option 1 2 3 4
Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?* Select Answer Dog Walker Dog Sitter Other
Have You Ever Owned A Dog Before?* Will This Be Your First Dog* Please Describe*
Dog 1 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Danish-Swedish Farmdog Hound - Posavac Chiweenie Mi-Ki
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 5 - 12 Months ) Youth ( 13 - 36 Months ) Adult ( 37 - 108 Months ) Senior ( 108+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Temperament Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Current on All Vaccines?* When Was Dog Last Examined by Veterinarian and Vaccinated (approximate month & year)*
Current on Heartworm Test and Kept on Heartworm Prevention For Every Season?* What Brand of Food Does Your Current Dog Eat*
Please tell us more about your current dog's personality, level of activity, do they enjoy the company of other dogs, will they readily play with other dogs, do they enjoy the dog park, as much as you can tell us so we can ensure to make the best match
Dog 2 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Danish-Swedish Farmdog Hound - Posavac Chiweenie Mi-Ki
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 5 - 12 Months ) Youth ( 13 - 36 Months ) Adult ( 37 - 108 Months ) Senior ( 108+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Temperament Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Current on All Vaccines?* When Was Dog Last Examined by Veterinarian and Vaccinated (approximate month & year)*
Current on Heartworm Test and Kept on Heartworm Prevention For Every Season?* What Brand of Food Does Your Current Dog Eat
Please tell us more about your current dog's personality, level of activity, do they enjoy the company of other dogs, will they readily play with other dogs, do they enjoy the dog park, as much as you can tell us so we can ensure to make the best match
Dog 3 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Danish-Swedish Farmdog Hound - Posavac Chiweenie Mi-Ki
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 5 - 12 Months ) Youth ( 13 - 36 Months ) Adult ( 37 - 108 Months ) Senior ( 108+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Temperament Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Current on All Vaccines?* When Was Dog Last Examined by Veterinarian and Vaccinated (approximate month & year)
Current on Heartworm Test and Kept on Heartworm Prevention For Every Season?* What Brand of Food Does Your Current Dog Eat
Please tell us more about your current dog's personality, level of activity, do they enjoy the company of other dogs, will they readily play with other dogs, do they enjoy the dog park, as much as you can tell us so we can ensure to make the best match
Dog 4 Dog's Name*
Where Did You Get The Dog?* Select Source Friend Puppy of Another Dog Puppy of My Dog Shelter Rescue Stray Other
Please Explain*
Is Dog Still Living With You?* How Long Did You Own Him/Her?* Select Option 0-3 Months 4-6 Months 7-11 Months 1 Year 2 Years 3 Years 4 Years 5-10 Years 11 Years +
Why not?* Select Option Died of Natural Causes Euthanized Gave Dog Away Dog Ran Away Other
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed* Select Breed Mix Mutt Dad Is the Milkman Heinz 57 Akbash Akita Inu Alaskan Malamute American Blue Heeler American Eskimo Appenzell Mountain Dog Ausiedoodle Ausiepoo Australian Cattle Australian Kelpie Australian Shepherd Azawakh Basenji Beagle Beauceron Bergamasco Bernadoodle Bernese Mountain Dog Bichon Frisé Black Mouth Cur Blue Lacy Boerboel Borzoi Bolognese Bouvier des Flandres Boxer Briard Brittany Brussels Griffon Bulldog Bulldog - American Bulldog - English Bulldog - French Canaan Cane Corso Carolina Dog Catahoula Leopard Dog Cattle Dog Cavapoo Cheweenie Chihuahua Chinese Crested Chinese Shar-Pei Chinese Foo Dog Chinook Chow Chow Cirneco dell’Etna Cockapoo Collie Collie - Bearded Collie - Border Collie - Rough Collie - Smooth Corgi Corgi - Cardigan Welsh Corgi - Pembroke Welsh Coton de Tulear Dachshund Dachshund - Miniature Dachshund - Wirehaired Dalmatian Dogo Argentino Dogue de Bordeaux Entlebucher Mountain Dog Eskimo Dog Feist Fila Brasileiro French Bordeaux Goldendoodle Great Dane Great Pyrenees Greater Swiss Mountain Dog Hamiltonstovare Harrier Havachon Havamalt Havana Silk Dog Havanese Havapoo Havashire Havatzu Havawart Hound Hound - Afghan Hound Hound - American Coonhound Hound - American Foxhound Hound - Basset Hound Hound - Black and Tan Coonhound Hound - Bloodhound Hound - Bluetick Coonhound Hound - Coonhound Hound - English Coonhound Hound - English Foxhound Hound - Finnish Lapphund Hound - Foxhound Hound - Galgo Spanish Greyhound Hound - Greyhound Hound - Ibizan Hound - Irish Wolfhound Hound - Italian Greyhound Hound - Keeshond Hound - Norwegian Buhund Hound - Norwegian Elkhound Hound - Norwegian Lundehund Hound - Otterhound Hound - Pharaoh Hound Hound - Plott Hound Hound - Redbone Coonhound Hound - Saluki Hound - Scottish Deerhound Hound - Swedish Vallhund Hound - Treeing Walker Coonhound Husky Husky - Siberian Spinone Italiano Japanese Chin Jindo Kai Dog Karelian Bear Dog Kishu Klee Kai Komondor Kuvasz Kyi Leo Labradoodle Lancashire Heeler Leonberger Lhasa Apso Lowchen Malshi Maltese Maltipom Maltipoo Mastiff Mastiff - Bull Mastiff - Neapolitan Mastiff - Tibetan McNab Morkie Mountain Cur Mountain Dog Munsterlander Native Amer Indian Dog (NAID) New Guinea Singing Dog Newfoundland Papillon Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendéen Pinscher Pinscher - Affenpinscher Pinscher - Doberman Pinscher - German Pinscher - Miniature Portuguese Podengo Pointer Pointer - English Pointer - German Shorthaired Pointer - German Wirehaired Pointer - Wirehaired Pointing Griffon Pomeranian Poodle Poodle - Miniature Poodle - Standard Poodle - Teacup Poodle – Toy Presa Canario Pequeno Portuguese Water Dog Pug Puli Pumi Retriever Retriever - Black Labrador Retriever - Chesapeake Bay Retriever - Chocolate Labrador Retriever - Curly-Coated Retriever - Flat Coated Retriever - Golden Retriever - Labrador Retriever - Nova Scotia Duck Tolling Retriever - Yellow Labrador Rhodesian Ridgeback Rottweiler Saint Bernard Samoyed Sarplaninac Schipperke Schnauzer Schnauzer - Giant Schnauzer - Miniature Schnauzer - Standard Setter Setter - English Setter - Gordon Setter - Irish Shar-Pei Sheepdog Sheepdog - Belgian Sheepdog - Caucasian (Ovtcharka) Sheepdog - Icelandic Sheepdog - Illyrian Sheepdog - Maremma Sheepdog - Old English Sheepdog - Polish Lowland Sheepdog - South Russian Ovtcharka Sheepdog - Shetland Shepherd Shepherd - Anatolian Dog Shepherd - Australian Shepherd - Belgian Laekenois Shepherd - Belgian Malinois Shepherd - Belgian Tervuren Shepherd - Dutch Shepherd - English Shepherd - German Shepherd - Pyrenean Shepherd - White German Shiba Inu Shihpoo Shih Tzu Shorkie Sloughi Spaniel Spaniel – American Cocker Spaniel - American Water Spaniel - Boykin Spaniel - Brittany Spaniel - Cavalier King Charles Spaniel - Clumber Spaniel – English Cocker Spaniel - English Toy Spaniel - Field Spaniel - Irish Water Spaniel - English Springer Spaniel - Springer Spaniel - Sussex Spaniel - Welsh Springer Spaniel - Tibetan Spanish Water Dog Spitz Spitz - Finnish Spitz - German Terrier Terrier - Airedale Terrier - American Hairless Terrier - American Pit Bull Terrier - American Staffordshire Terrier - Australian Terrier - Bedlington Terrier - Biewer Terrier - Black Russian Terrier - Boston Terrier - Border Terrier - Bull Terrier - Cairn Terrier - Cesky Terrier - Dandie Dinmont Terrier - Fox Terrier - Glen of Imaal Terrier - Irish Terrier - Jack Russell Terrier - Kerry Blue Terrier - Lakeland Terrier - Manchester Terrier - Miniature Bull Terrier - Norfolk Terrier - Norwich Terrier - Parson Russell Terrier - Patterdale / Fell Terrier - Rat Terrier - Scottish Terrier - Sealyham Terrier - Smooth Fox Terrier - Silky Terrier - Skye Terrier - Staffordshire Bull Terrier - Tibetan Terrier - Toy Fox Terrier - Toy Manchester Terrier - Welsh Terrier - West Highland White (Westie) Terrier - Soft Coated Wheaten Terrier - Wire Fox Terrier - Wirehaired Terrier - Yorkshire (Yorkie) Thai Ridgeback Tosa Inu Vizsla Weimaraner Whippet Yorkiepoo Xoloitzcuintli Danish-Swedish Farmdog Hound - Posavac Chiweenie Mi-Ki
Age Range* Select Age Range Baby ( 0 - 5 Months ) Puppy ( 5 - 12 Months ) Youth ( 13 - 36 Months ) Adult ( 37 - 108 Months ) Senior ( 108+ Months )
Gender* Select Gender Female Male
Status* Select Status Neutered Spayed Not Altered
Please Explain Why Not*
Sociability* Select Temperament Very Social Social Somewhat Social Not Social
Sleeping Quarters* Select Sleeping Quarters In Bedroom In Kid's Room In Other Room In Garage Outside Inside & Outside with Doggie Door
Current on All Vaccines?* When Was Dog Last Examined by Veterinarian and Vaccinated (approximate month & year)
Current on Heartworm Test and Kept on Heartworm Prevention For Every Season?* What Brand of Food Does Your Current Dog Eat
Please tell us more about your current dog's personality, level of activity, do they enjoy the company of other dogs, will they readily play with other dogs, do they enjoy the dog park, as much as you can tell us so we can ensure to make the best match
Other Pets Are There Other Pets In The Home?* How Many?* Select Option 1 2 3 4
Other Pet 1 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Name of Cat*
Age of Cat & Breed*
When Was Cat Last Examined by Veterinarian and Vaccinated*
Is Cat Spayed or Neutered*
If Female Cat, Has She Ever Had a Litter* Where Does Cat Reside* Strictly Indoors Indoor/Outdoor Strictly Outdoors Barn Cat Heated Building/Garage
Is Cat Declawed* If YES* Declawed by my vet Came to Me Already Declawed
Sociability Select Temperament Social with People & Other Animals Has Lived or Currently Lives With Dogs Has Not Lived With a Dog Timid Feral
Is There Any Additional Information You Would Like to Add?
Has a pet ever gone missing from your property or possession?* Please Describe What Type of Pet and What Were the Circumstances*
Other Pet 2 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Name of Cat*
Age of Cat & Breed*
When Was Cat Last Examined by Veterinarian and Vaccinated*
Is Cat Spayed or Neutered*
If Female Cat, Has She Ever Had a Litter* Where Does Cat Reside* Strictly Indoors Indoor/Outdoor Strictly Outdoors Barn Cat Heated Building/Garage
Is Cat Declawed* If YES* Declawed by my vet Came to Me Already Declawed
Sociability Select Temperament Social with People & Other Animals Has Lived or Currently Lives With Dogs Has Not Lived With a Dog Timid Feral
Is There Any Additional Information You Would Like to Add?
Has a pet ever gone missing from your property or possession?* Please Describe What Type of Pet and What Were the Circumstances*
Other Pet 3 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Name of Cat*
Age of Cat & Breed*
When Was Cat Last Examined by Veterinarian and Vaccinated*
Is Cat Spayed or Neutered*
If Female Cat, Has She Ever Had a Litter* Where Does Cat Reside* Strictly Indoors Indoor/Outdoor Strictly Outdoors Barn Cat Heated Building/Garage
Is Cat Declawed* If YES* Declawed by my vet Came to Me Already Declawed
Sociability Select Temperament Social with People & Other Animals Has Lived or Currently Lives With Dogs Has Not Lived With a Dog Timid Feral
Is There Any Additional Information You Would Like to Add?
Has a pet ever gone missing from your property or possession?* Please Describe What Type of Pet and What Were the Circumstances*
Other Pet 4 Animal Type* Select Animal Type Cat Bird Small Animal Barn Animal Reptile
Name of Cat*
Age of Cat & Breed*
When Was Cat Last Examined by Veterinarian and Vaccinated*
Is Cat Spayed or Neutered*
If Female Cat, Has She Ever Had a Litter* Where Does Cat Reside* Strictly Indoors Indoor/Outdoor Strictly Outdoors Barn Cat Heated Building/Garage
Is Cat Declawed* If YES* Declawed by my vet Came to Me Already Declawed
Sociability Select Temperament Social with People & Other Animals Has Lived or Currently Lives With Dogs Has Not Lived With a Dog Timid Feral
Is There Any Additional Information You Would Like to Add?
Has a pet ever gone missing from your property or possession?* Please Describe What Type of Pet and What Were the Circumstances*
PREVIOUS PETS Have You Previously Owned a Dog* Please Describe How Many, What Breed For Each, How Long Owned For Each, Why No Longer Own Each of Them*
Have You Ever Turned a Pet Into a Shelter Or Rescue Please describe what type of Pet(s), circumstance for surrendering, name of shelter or rescue*
Veterinarian Information Have You Used A Veterinarian or Veterinary Clinic Before?* Please Provide Veterinary Clinic Name:*
Please Provide Vet Clinic Phone Number:*
How Long Have You Been A Client At This Clinic*
What Vet Clinic Do You Plan To Use For A New Pet*
