Thank you for your interest in adopting a dog from RePets or the BGWC Humane society. We are so glad you have chosen to rescue an animal, because when you adopt from a shelter or a rescue you save 2 lives. The one you adopted and the cage you opened for another animal.

Which dog do you want to adopt?:

Entire Name:

Home Address:

City:

State:

Zip Code:

Phone Number:

E-mail Address:

Date of Birth:

Driver's License #:

State of Driver's License:

Place of Employment:

Work Phone Number:

Why are you adopting this dog?:
Companion
Family Pet
Guard/Watch Dog
Companion for another pet
Hunting
Gift
Other

If you chose other, please explain:

For whom are you adopting this dog?:
Self
Spouse
Friend
Boyfriend/Girlfriend
Children
Mom/Dad
Someone that lives in a different house

Where will your dog be kept?:
House
Yard
Garage
Chain
Farm
Out Door Kennel
Cable Runner/Tie Out
Crate

How many acres is your farm?:
Under 10 Acres
10-50 Acres
51-100 Acres
100+ Acres
I do not live on a farm

Do you have a fenced yard?:
Yes
No

If you do have a fenced yard, what type of fencing is used?:
Chain Link
Cattle Fence
Electric Fence
Kennel
Privacy Fencing
Yard is partially fenced
Underground Dog Fencing
Planning on putting up a fence in the near future
I do not have a fenced yard, and I will not be putting one up

If you do not have a fenced yard, how will you supervise your pet when outdoors?:
Leash Walk
Run Loose
Kennel
Chain
Cable Runner/Tie Out
Live on a Large Farm or Rural Area
Electric Fence
Planning I will be outdoors w/ my pet
Pet will not be outdoors

What is the estimated distance from your house to the road?:

Where will the dog be kept incase of extreme winter and extreme summer weather conditions?:

Have you ever adopted from RePets or the BGWC Humane Society before?:
Yes
No

If yes, what did you adopt and how long ago?:

How many animals do you currently have?:

Pet 1:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 2:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 3:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 4:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 5:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 6:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 7:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Pet 8:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Is this pet spayed/neutered?: Yes No No, I breed this pet
Is this animal alpha or submissive?: Alpha Submissive I don't know	Is this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Please tell us about this pets personality & living arrangements:

Previous Pet 1:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 2:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 3:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 4:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 5:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 6:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 7:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Previous Pet 8:
Pet Name:	Species:	Breed:
Age:	Gender: Male Female	Was this pet spayed/neutered?: Yes No No, I bred this pet
Was this animal kept inside or outside?: Inside Outside Free to go indoor/outdoor Other (Please explain in next box)	Why do you no longer have this pet, what happened?:

Do you mind if we call your previous and/or current vet for a reference?:
Yes
No

Previous or Current Vet's Name:

Previous or Current Vet's Phone #:

What name is the vet account under?:

If you listed any pets as NOT being spayed/neutered, please explain why they were not altered?:

Do you know what heartworm is?:
Yes
No

Are/were your current/previous dogs on heartworm preventative?:
Yes
No
I've never had a dog

If no, please explain why not?:

Are/where your current/previous pets given their yearly vaccines (rabies, boosters, etc)?:
Yes
No
I've never had a pet before

If no, please explain why not?:

Do you agree to keep this dog on monthly flea/tick preventative ($5-$15 per month)?:
Yes
No

Do you agree to keep this dog on monthly heartworm preventative ($5-$15 per month)?:
Yes
No

Do you agree to keep this dog up-to-date on yearly vaccines (as well as any boosters it might need, price varies by vet)?:
Yes
No

Have you ever surrendered an animal to an animal shelter or rescue group?:
Yes
No

If Yes, WHERE did you surrender them, and WHY did you surrender them, and WHEN did you surrender them (we need you to be as specific as possible on this)?:

Please check ALL the reasons you would return your adopted dog?:
Aggressive Behaviors (such as biting, not good w/kids)
If the animal gets larger than expected
Chewing furniture or other non-chew toys
If dog is not housetrained
If the children quit taking care of the dog
If my family moves
Divorce
Having a baby
Allergies
Personal Health Issues
If dog has accident in the house
Shedding
If dog is not leashed trained
If care for the animal becomes too time consuming
If the pet has medical problems
would never give my pet up for any reason

What type of dwelling will the dog be living in?:
House
Condo
Apartment
Mobile Home

What type of setting is the home located?:
Urban
Suburban
Rural

Please choose the relationship of the home to that of the dogs potential owner?:
Own
Rent
Rent to Own
Live with parents
Live with friends/family (rent free)

Are there other people living in the dogs home besides the potential owner?:
Yes
No

If yes, how do the other members of the household feel about adding a new dog to the home?:

If you have a landlord, what is their full name (first name only is not acceptable)?:

If you have a landlord, what is their phone number (with area code)?:

If you live with your parents, or with family/friends (in the case that you do not pay rent) what is their full name (first name only is not acceptable)?:

If you live with your parents, or with family/friends (in the case that you do not pay rent) what is their phone number (with area code)?:

Are there any children that will be living in the home with the dog, or that will be visiting the home where the dog lives?:
Yes
No

If yes, what are the childrens ages?:

What form of discipline do you use or plan to use?:

What will happen to the dog if you are unable to housebreak it?:

Do you have a problem with us doing a follow up call or visit?:
Yes
No

If you are requesting the adoption of an animal that we feel needs a fenced yard or special attention do you agree that we may do a home visit before the animal goes home to verify that your home does have a fenced yard?:
Yes
No

If you give this pet up for any reason, do you understand that you MUST bring the animal back to this shelter?:
Yes
No

Do you understand that if ANY of the information on this application is found to be false, or if we find the animal you are adopting from us is not being given proper care (personal or veterinarian), we WILL reclaim the animal, this includes living situations not being the same as on this application?:
Yes
No

Do you understand if we feel the animal you have chosen is not likey to work out in your situation, we may decline the application, FOR ANY REASON? (We will work with you to recommend an animal that best suits your needs):
Yes
No

Do you understand that the BGWC Humane Society & Adoption Center is not responsible for medical center after the pet you have adopted goes home?:
Yes
No

Your application WILL NOT be considered if you skipped any question. If the question didn't apply to you, mark it N/A.