NEADS Furloughed Favorite Application
In case of emergency, please provide the name of a relative that we can call if we cannot reach you.
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Emergency Contact Relationship
How did you hear about the NEADS Furloughed Favorites program?
Why do you want a Furloughed favorite?
Who will be the dog's primary caretaker?
Please provide two personal references that we may contact.
Second Reference Contact Details
Please describe your neighborhood (for example, busy road, neighbors close by, dogs/cats running) .
Do you live in a one level or multi-level home?
Do you own or rent?
If you are renting, please fill out the details below.
Have you discussed this application with your landlord?
Do you have written permission from your landlord to own a dog?
Do you live in a house or apartment?
What floor do you live on?
Third or Above
How many units are in your building?
Is it a single building or complex of buildings?
Complex of buildings
Do you have a yard?
Is your yard fenced?
Does the fence encircle the yard?
What is the height of the fence?
How many people do you live with?
10 or more
Please list below name, relationship, and age of people living with you.
Do you have frequent visitors?
Are there other dogs in your household?
If so, what is the age of the dog? male/female? neutered? friendly to other dogs?
Please list other pets:
Have you ever had a dog before?
If so, what breed(s) and when? What happened to the dog(s)?
Have you ever sold, given away, or surrendered a pet?
If so, why?
How often would you leash walk your dog?
How many hours per day would the dog be alone? Please enter a single digit (i.e. 4).
Where will your dog be kept during the day?
Where will your dog be kept at night?
Where will your dog be taken for toilet requirements?
Where will your dog be taken to be exercised and have play time?
Would you let your dog run free outside of an enclosure?
Do you travel a lot?
Once a month
Once every 6 months
Once a year
Would you take your dog with you on trips?
Are you familiar with crate training?
Do you plan on using a crate with your dog?
Do you plan to allow this dog on furniture?
Are you willing or planning to attend a training class with your new dog?
Is there a particular breed/type of dog that you would prefer to adopt?
What size of dog do you prefer?
Small (up to 25 lbs.)
Medium (25-50 lbs.)
Large (over 50 lbs.)
What hair length do you prefer?
What energy level would you prefer?
Is there a particular breed/type of dog that you do not like?
Please list any other information that may be helpful to us in selecting a proper dog for you:
Veterinarian Contact Information
Do we have your permission to contact your veterinarian?
By checking this box, I attest that all information in this application is true and correct to the best of my knowledge.
**Please review the information you provided. You will not be given the opportunity to edit this information after you click the submit button. Thank you!