Canine Angels Service Teams

13475 N. Applegate Rd.
Grants Pass, OR. 97527
888 K9 ANGLSĀ  orĀ 541 846-6400
www.Canine-Angels.org email: info@Canine-Angels.org

Career Change Dog Application

GENERAL INFORMATION

Name:

Address 1:
Address 2:
City:
State:
Zip:

Phone:
E-Mail:
Is there anyone in your household with special needs?

Do you own your home? Yes No
Do you rent? Yes No
If yes, do you have your landlord's permission? Yes No
Landlord's Name:
Landlord's Phone:
Occupation:
Spouse's Occupation:
Is someone home most of the day? Yes No
Where will you put the dog when you are not home?
Will you be leaving the dog home alone a lot? Yes No
What is your dog experience? (breeds of dogs you have previously owned, obedience classes taken, etc)
Please list names and relationship of all people living in your home and ages of minors:
Please list all household pets and livestock, including species and ages:
Veterinarian's Name:
Veterinarian's Phone:
Do you want a certain breed?

Yes
only want the below selected breed
no preference
What breed?
I prefer the above selected breed, but I will take any dog that is a good fit for my family Yes
Do you have a color preference?
Do you have an age preference?
Do you have a gender preference?
Are you prepared to take a dog now? Yes Not yet
Approximate ready date:
Is there anything else you would like us to know?