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2. Name:
3. Email:
5. Address:
7. Primary Phone:
8. Alternate Phone:
10. 1.) Name of the dog that you are interested in (if applicable):
12. 2.) Do you currently live in a

    1. House

    1. Apartment

    1. Condo

    1. Other
14. 3.) Do you currently

    1. Rent

    1. Own

    1. Lease
16. If you are not the property owner, the Ft. Gibson ACO will verify your residences current pet policy.
18. Landlord's Name:
19. Landlord's Phone Number:
21. 4.) Which of the following best describes your reasons for wanting a dog? (Check all that apply)

    1. Companion
    2. Search & Rescue
    3. Guard Dog

    1. Agility
    2. Hunting
    3. Jogging

    1. Breeding
    2. Walking Buddy

    1. Obedience Training
    2. Couch Warmer
23. 5.) Where will the dog be kept when no one is home?
25. 6.) Where will the dog be kept at night?
27. 7.) Do you have a fenced yard?

    1. Yes

    1. No
29. 8.) Do you have a regular veternarian?

    1. Yes

    1. No
30. Name of Veterinarian:
32. 9.) Please describe the temperment and activity level you are looking for in a dog. Check all that apply:

    1. High Energy
    2. Outdoorsy Dog

    1. Lap Dog
    2. Mellow

    1. Affectionate
    2. Quiet

    1. Guard Dog
34. 10.) I prefer a dog that.... (Check all that apply)

    1. Loves children and strangers
    2. Can tolerate children and strangers

    1. Loves all other animals
    2. Can tolerate all other animals

    1. Don't care if he/she gets along well with other animals
36. I certify that the above information is true and correct to the best of my knowledge. I also ackowledge falsification of the above can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of that animal to the Ft. Gibson animal shelter.
38. Signed:
39. Date:
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

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