| First Name: |
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| Last Name: |
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| Street Address: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Phone Number: |
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| Email: |
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| Your occupation: |
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| Your age: |
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| Do you rent or own? |
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| If you rent, type in your landlord's name and phone number: |
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| Ages of other members in your home: |
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| How did you hear about CAPS? |
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| Name of dog you wish to adopt: |
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| Who would be the primary caregiver? |
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| Who would care for the dog if your family went on vacation? |
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| Where will the dog be kept during the day? |
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| Where will the dog be kept at night? |
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| Approximately how many hours a day would the dog be left alone? |
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| What behaviors do you consider unacceptable in a dog? |
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| Under what circumstances would you give up a dog? |
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| What training methods do you plan on using if you adopt a dog? (applies to all ages) |
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| Please provide a pet history of the last 10 years (gender, age, spay/neuter, where they are now) |
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| If you have a pet, please provide the vet's name, address, and phone number: |
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| List the names and phone numbers of 2 references unrelated to you: |
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| How do you plan to meet the toilet and exercise needs of the dog? |
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| Gender Preference: |
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| Energy Level: |
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| Size: |
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| Is shedding a concern? |
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| Is noise a concern? |
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| Do you have a fenced yard? |
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| Will the dog be tied up? |
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| Are you able to come home during the day from work? |
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| Is anyone in your home allergic to pets? |
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| Is anyone in your home deployed? |
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| Will you consider obedience training? |
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| Are all members of the home in agreement of adopting a dog? |
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| Have you ever had a pet die at a young age or from an accident? |
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| Have you ever lost or given away a pet? |
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| Have you submitted applications to other rescue organizations? |
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| Are you aware of CAPS's spay/neuter policy? |
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| Are you willing to sign an adoption contract? |
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