Which dog are you applying for?
Name
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?	Select One Yes No
Does anyone in your household smoke?	Select One Yes No
What type of home do you live in?	Select One House Condo / Townhouse Apartment Duplex / Triplex Mobile Home
Do you own or rent your home?	Select One Own Rent
If you rent, please provide us with the name & phone number of your landlord	Name: Phone:
Do you have a completely fenced yard?	Select One Yes No
How tall is your fence (at it's lowest point)?
What type of fence?	Select One Brick Privacy Wood Picket Wood Chain Link Invisible No Fence
Is there a gate?	Select One Yes No
Where is your gas & electric meters - inside or outside of the fenced area?	Select One Inside Fence Outside Fence
Do you have a pool?	Select One Yes No
If Yes, what type of pool?	Select One Built-In Above Ground
If Yes, is your pool gated?	Select One Yes No
Are there stairs that lead to your home?	Select One Yes No
Do you have a doggie door?	Select One Yes No
Do you currently have any pets?	Select One Yes No
If Yes, please provide us with the following information about each pet:

	Type of Pet (ie dog, cat, bird, etc.)	Breed	Gender	Age	Spayed / Neutered?	Fully Vaccinated?
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?	Select One Yes No
If Yes, please provide us with the name & phone number of your vet's office	Name: Phone:
Describe the dog you are looking for
Why do you want this dog?
Is this your first dog?	Select One Yes No
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?	Select One Yes No
Would you be able & willing to exercise the dog on a regular basis?	Select One Yes No
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?	Select One Yes No Possibly
Will the dog spend any time in the garage?	Select One Yes No Possibly
If you drive a pickup truck, would you allow the dog to ride in the back?	Select One Yes No
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?	Select One Yes No
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?	Select One Yes No
Are you willing to allow a STOP representative to come to see where the dog will be living?	Select One Yes No

 

NOTE: Due to the overwhelming response and multiple Applications received, only the selected Applicant will be contacted directly.