ONLINE ADOPTION FORM
Please fill out all areas where possible.

First Name   Last Name

Home Phone     Work Phone

Fax

Email

Address  City

State Zip

Best time to call At home 8am - Noon At home Noon - 6pm At home 6pm - 9pm At work 8am - Noon At work Noon - 5pm

Your Occupation

 
Do you own or rent your home? Own Rent

If you rent: Do you have your landlord's permission to keep a dog? Yes No

Landlord's Name Landlord's Phone

Do you live in a House Apartment Trailer Other

If "Other", please describe

How long have you lived at this address? years

Do you have a fenced yard? Yes No N/A

If you don't have a fenced yard, how will you handle the dog's exercise and toilet duties?

If you have a fenced yard:

Fence height Fence type

Does fencing completely enclose a yard for the dog? Yes No

Do you have a separate kennel run? Yes No

If you have a separate kennel run:

Kennel height Kennel size  

Where will dog spend the day? Loose Indoors Crate Basement Garage Fenced Yard Kennel Run Tied Up Outdoors Loose Outdoors Other (Check all that apply)

If other, describe

Where will dog spend the night? Loose Indoors Crate Basement Garage Fenced Yard Kennel Run Tied Up Outdoors Loose Outdoors Other (Check all that apply)

If other, describe

How many hours on the average will the dog spend alone?   1-2 2-4 4-6 6-8 8+

How many adults in household? 1 2 3 4 5 How many children? 0 1 2 3 4 5

Age and sex of children (if applicable)

Are there regular visitors to your home (human or animal) with which your new dog must get along? Yes No

If so, describe

If you have livestock or farm animals, please list the types

Do you own other dogs? Yes No

If so, give breed, sex, and age of each, also which have been neutered/spayed

Do you own cats? Yes No

If so, how many? 0 1 2 3 4 5 6

Do you own other animals? Yes No

Name of regular veterinarian
Phone

Vet's Address

How many dogs have you owned in the last five years? 1 2 3 4 5 None

List breeds and indicate if you still own the dogs

For dogs you no longer own, what happened to them? (be specific)

Have you owned a Catahoula before? Yes No

Why do you choose the Catahoula?

Plans for this dog Pet Guard Hunting Herding Obedience Other (Check all that apply)

If "Other", describe

Do you want to adopt Male Female No Preference

Color preference Age preference

I have marked my preferences above, but would be willing to consider a suitable dog of a different
Sex Color Size Age (check all that apply)

How active a dog are you looking for? Above Average Average Below Average Couch Potato

If you are interested in a particular Catahoula Rescue, Inc. dog, which one?

And if so, where did you hear about the dog? (please try to be specific)

If you are already working with a particular rescue rep, which one?

Do you understand Catahoula Rescue, Inc. requires this dog be spayed or neutered? Yes No

Do you agree to license this dog and give regular health care? Yes No

Do you agree to contact Catahoula Rescue Inc. if you can no longer keep this dog?   Yes No

Would you be willing to let a representative of Catahoula Rescue Inc. visit your home by appointment? Yes No

If not, why?

How did you hear about us? Web Search Another Rescue Site From a person

May we add you to our mailing list? Yes No

By submitting this application, I declare that all of the above information I have given is true and complete.  

After filling out the form, please press the Submit button below which will forward your application form to Catahoula Rescue, Inc. for processing. Please do not submit the form until you have completed it, and avoid submitting it more than once.