Phone:  661-823-4100   •   Email:
S.T.O.P.   ©   2008 - 2018   •  ALL RIGHTS RESERVED

Which dog are you applying for?
Address (no P.O.Box)
City,  State, &  Zip
Home Phone
Cell Phone
Email Address
Your Age
How many other adults live in your household?
What are their ages?
How many children live in your household?
What are their ages?
Does any member of your household have an allergy to dogs?
Does anyone in your household smoke?
What type of home do you live in?
Do you own or rent your home?
If you rent, please provide us with the name & phone number of your landlord Name:


Do you have a completely fenced yard?
How tall is your fence (at it's lowest point)?
What type of fence?
Is there a gate?
Where is your gas & electric meters - inside or outside of the fenced area?
Do you have a pool?
If Yes, what type of pool?
If Yes, is your pool gated?
Are there stairs that lead to your home?
Do you have a doggie door?
Do you currently have any pets?
If Yes, please provide us with the following information about each pet:

  Type of Pet
(ie dog, cat, bird, etc.)
Breed Gender Age Spayed /
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6

If you currently own pets, how will they adjust to a new pet entering their household?
What kind of pets have you had in the past?
Were they all spayed or neutered?
If not, why not?
What happened to your previous pets?
Have you ever turned a pet into a shelter or rescue organization?
If Yes, please explain the circumstances
Have you had a pet euthanized?
If Yes, please explain the circumstances
Where your previous dog(s) obedience trained?
Do you currently have a veterinarian?
If Yes, please provide us with the name & phone number of your vet's office Name:


Describe the dog you are looking for
Why do you want this dog?
Is this your first dog?
If your new dog/puppy is not housebroken, what method will you use to train it?
Will you keep the dog up to date on vaccinations?
Would you be able & willing to exercise the dog on a regular basis?
Method of exercise:
Is someone home during the day?
How many hours each day will the dog be without human companionship?
Are there times when the dog will be tied up?
Will the dog spend any time in the garage?
If you drive a pickup truck, would you allow the dog to ride in the back?
If you go away for a few days, or on a vacation, who will take care of the dog?
If you move, will you take the dog with you?
How much are you willing to spend on medical bills for your dog?
What would you do if the vet bills go over this amount?
What provisions will you make for the dog should you become unable to care for it?
Are you willing to take responsibility for this dog for the next 10 to 15 years?
Have you ever applied to adopt an animal from S.T.O.P. in the past?
Are you willing to allow a STOP representative to come to see where the dog will be living?