GREAT DANE RESCUE OF AZ ALLIANCE

PERSONAL AND HOUSEHOLD INFORMATION

First Name
Last Name
Street Address
City
State
Zip
Daytime Phone
Evening Phone
Email Address
Up until what time of night can we contact you via phone?

Are you 18 years of age or older?
How many people live in your household?
If you have children, list their age(s)
If no children, do you plan on having children or will children be visiting the household frequently?

What type of home do you live in?
Do you own or rent?
If you rent, please provide your Landlord Name and Phone Number	Name: Phone:
Do you have a fenced yard?
If so, what type of fence?
What is the height of your fence, at the lowest point?
Do you have locks and/or latches on all your gates? If no gates, select N/A
Do you have an in-ground pool?
If so, is it fenced?

Please define your household: (Check all that applies)	Busy (visits by friends, children, parties) Noisy (TV, stereo, machinery, tools, children playing) Moderate (normal comings and goings) Quiet (Homebodies, few guests, stay home a lot) Live on a quiet cul-de-sac Lots of children in neighborhood Live on a busy street or highway

PET OWNERSHIP INFORMATION

What dog are you applying for?

Where will this dog be kept during the day?
Where will this dog be kept during the night?
How many hours will this pet be left alone each day?
Do you currently have any pets?
If Yes, please provide the following information:

If you have more than 3 pets currently, please use this text box to provide the same information for each additional pet.
Do you currently have a Veterinarian?
If so, please provide your vet's name and phone number:	Name: Phone:

Is your entire immediate family in agreement with the decision to bring a new pet into your home?

Additional comments or questions:

Please remember, it may take approximately 2 to 3 business days for us to get back to you.

Thank you so much for wanting to rescue a dog!!