First Name
Last Name
Address
City
State
Zip
Home Phone
Email

How did you hear about us?

Are you currently working with any other rescue organizations? If so, which one(s)...

What made you decide on a Brittany?

Have you ever had a Brittany (or other dog)? If yes, what happened to it?

Do you have other pets?

Indicate any type of dog you looking for:

What traits are you looking for in a dog?

Do you have children? What ages?

Do you rent or own your home?

Own
Rent

If rent, can we contact your landlord to verify that pets are okay?

Yes
No

Landlord's contact information.

Do you have a fenced yard? How large? How high is the fence? Have you checked it for escape routes?

How much time will the dog spend alone? Where will he/she be?

Where will the dog sleep?

What activities would you like to do with your dog?

Are you interested in obedience-training your dog?

Yes
No

Do you intend to crate-train your dog?

Yes
No

Would you be willing to allow us to visit you and your new dog after the adoption?

Yes
No

No, because

If, for some reason, you are not able to adopt one of these animals, would you be interested in dogs that may become available in the future?

Yes
No

Please understand that most rescue dogs are older, and make wonderful pets.

Are you willing to give the dog at least 6 months to adjust to you, your family, and the new environment?

Yes
No

For what prime reasons would you give up, or get rid of a dog?

May we contact your veterinarian for a reference? If no, please explain. If yes, please include your vet's name and phone number.

If you are interested in any particular Brittany currently featured on our website please indicate which one(s)

Do you have any questions or concerns about adopting a rescued dog that we might be able to answer?