NEADS Furloughed Favorite Application

Personal Information

First Name

Last Name

Street Address

City

State

Zip Code

Cell Phone Number

Home Phone Number

Your Application

How did you hear about the NEADS Furloughed Favorites program?

Why do you want a Furloughed favorite?

Living Arrangements

Who will be the dog's primary caretaker?

Do you live in a city, suburb, or rural environment?

Do you own or rent?

Have you discussed this application with your landlord?

Do you have written permission from your landlord to own a dog?

Landlord's Name

Landlord's Phone

Do you live in a house or apartment?

Do you have a yard?

Is your yard fenced?

Does the fence encircle the yard completely?

What is the height of the fence?

What is the material of the fence?

Household Members and Pets

How many people do you live with?

Are there any members who live there part-time?

If yes, how many?

Please list below name, relationship, and age of people living with you.

If you have children, do they have experience with dogs?

Do you have frequent visitors?

Do you or anyone in your household have a dog now?

If so, what is the breed and age of the dog(s)? Please list for each dog breed, age, male/female? spayed/neutered? friendly to other dogs?

Please list other pets (type, age, spay/neutered, friendly to dogs?):

If you have cats, are they comfortable with dogs?

Lifestyle

How frequently do you travel?

Would you take your dog with you on trips?

Do you plan to use this dog as a therapy dog for yourself or others?

What are your hobbies/interests?

Dog Care

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?

Have you ever used pet care services?

If so, please explain:

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).

What activities are you planning on doing with your dog?

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?

Are you familiar with crate training?

Do you plan on using a crate with your dog?

Are you willing or planning to attend a training class with your new dog?

Veterinarian Contact Information

Name of veterinarian:

Veterinarian phone number:

Veterinarian address:

Do we have your permission to contact your veterinarian?

YesNo

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