Apply to Adopt About YouYou must be 21 to fill out this form and adopt. We only adopt out within a 3 hour radius of Las Vegas, NV. Please note that we verify home ownership with the County Assessors page. We do NOT adopt a female dog into a home with another female dog. No exceptions. Your Name* First Last Your Address* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Email* Enter Email Confirm Email Your Cell Phone*confirm Your Cell Phone*Additional phone numberWhat dog are you applying for?*Who is the dog for?* myself myself and my family someone not living in my home Is this your first dog?*Select OneYesNoWhy do you want a dog?*Describe your ideal dog.*Check all plans for the dog:* Pet Family member Obedience Guard Other If Other, please explain.*About Your HomeName of Person applying for dog*Age*Other person's Name living in the home or type the number 0:*Age or 0Other person's name living in the home or type the number 0:*Age or type the number 0:*Additional FIRST AND LAST NAME and AGES of everyone living in the home or type the number 0 in none:*Do you live in a:*Select oneHouseApartmentTownhomeCondoMobile homeHow Long have you lived at your current home?*Do you:*Select OneOwnRentLive with familyName of Person(s) that own the home?*Does your HOA, landlord or apartment allow pets?*Select OneYesNoIf renting, does your lease show the pet restrictions ie: breed, weight and/or age? Is the rental thru a property management company or individual. Property management companies almost always require prior approval before the dog is in the home .*Please send a copy of the lease (the pet section) showing the restrictions or ask for the pet addendum from the office to show your restrictions.*Accepted file types: doc, docx, pdf, jpg, jpeg, png, Max. file size: 300 MB.doc, docx, pdf,jpg, jpeg,pngHow many?*Size and weight limit/restrictions*If renting, landlord name*If renting, landlord phone*Do you have a fenced yard?*Select OneYesNoFence height*Block, wood, or chain link?*Do you have a doggy door?*Select OneYesNoDo you have a pool?*Select OneYesNoIf you have a pool, do you have a fence around it?*Select OneYesNoDo you have a crate?*Select OneYesNoDo you have a dog run?*Select OneYesNoIf you have a dog run, please explain when you plan to use it and why*Do you have a dog house?*Select OneYesNoIf you have a dog house, please explain when you plan to use it and why*About Your PetsDo you currently have pets?*Select OneYesNoList species, age and breed for pet 1:*Sex of pet 1* neutered Male spayed Female unaltered male unaltered female n/a List species, age and breed for pet 2 (or N/A if not applicable):Sex of pet 2* neutered Male spayed Female unaltered male unaltered female n/a List species, age and breed for pet 3 (or N/A if not applicable):*Sex of pet 3* neutered Male spayed Female unaltered male unaltered female n/a List male or female, spayed or neutered, species and breed for any other pets you own (or N/A if not applicable):*Have any of your dogs had Parvo or Distemper in your current home? If yes, please explain and list the dates or N/A if not applicable.*How many pets have you owned in the last 10 years?*Please enter a number from 0 to 9999.List the names, breed/kind, and what happened to all of the pets you no longer have:*Are your current pets:*Select OneInside 75% Outside 25%Inside 50% Outside 50%Inside 25% Outside 75%Outside 100%Will the new pet be:*Select OneInsideOutsideWhere do/will your pets/new pet spend the majority of their time?*Select OneInsideOutsideHow many hours a day will your dog be home alone?*How many hours a day/night will your dog be left outside?*Who is your veterinarian?*How will you deal with health issues, should the dog need special care later in life?*How often do/will you take your pet to the vet?*Select OneMonthlyAnnuallyAs necessaryHow do you intend on exercising your dog?*How long do you expect the adjustment period for your new dog to be?*What type of training will you provide for the dog?*Consent* By checking this box I agree that all of this information I provided is true and understand if any of the information I provided is false that I will be denied to adopt and any future adoptions?CAPTCHAUntitledUntitledUntitledUntitledNameThis field is for validation purposes and should be left unchanged.
