Name *

First Name

Last Name

Date

MM

DD

YYYY

Name *

First Name

Last Name

Co- Applicant Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What type of home do you live in? *

House

Condo

Apartment

Mobile Home

Other

Do you rent or own your home? *

Own

Rent

Do any of your current pets have aggression or dominance issues?

Yes

No

N/A, I don't have animals

Where will your pet be housed during the day? *

Inside- Kennel

Inside- Free Range

Outside-Kennel

Outside- Free Range in Fence

Where will your pet be housed during the night? *

Inside- Kennel

Inside- Free Range

Outside- Kennel

Outside- Free Range in Fence

Are you prepared to make a long-term commitment of several years to this pet? *

Yes

No

Are you prepared to make a financial commitment to the veterinary needs of your pet, both routine and emergency? *

Yes

No

Are you planning a move any time soon? *

Yes

No

Have you ever given up a pet? *

Yes

No

Have you owner a rescued animal in the past? *

Yes

No

Do you understand that some rescued animals may come with fears of behaviors that require time and patience? *

Yes

No

Date

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which of these skills would you like to utilize on the board? Check all that apply: *

Board Development

Strategic Planning

Financial Management

Fundraising

Community Outreach

Volunteer Management

Facilities Management

If you are selected to join the Board, can you commit to provide at least 2-4 hours a month in attendance to Board and Committee meetings, and that you do not have any conflict of interest in participating on our Board? *

Yes

No

If you are not selected for the Board or you ultimately decide not to join, would you like to be a volunteer to assist our organization in various ways that match your skills and interest? *

Yes

No

Maybe