Contact Information

First Name *

Last Name *

Occupation

Street Address *

City *

State *

Zip *

Work Phone

Home Phone *

E-mail Address *

Best Time to Call Mornings Afternoons Evenings No preference

Tell Us About Yourself

Age *

Marital Status *

Spouse's Name

Spouse's Occupation

Do you have children living with you currently? Yes No *

If so, please list the age and gender of each child:

Do you have children or grandchildren who visit you regularly? Yes No *

Are you willing to teach your children/grandchildren the responsibility of owning and caring for a greyhound? Yes No *

Please list any other persons living with you in your home:

*

Are all persons who live in your home in support of you adopting a greyhound? Yes No *

Does anyone in your home have allergies? Yes No

Tell Us About Your Home

What type of home do you live in? *

Do you Own Rent Other *

If you rent/lease your home, can you provide proof of permission from your landlord to have a large inside dog? Yes No (Proof of permission is required for adoption approval.) *

Do you have a fenced in yard? Yes No *

Do you have other pets in the house? Yes No *

If yes, please specify:

Veterinarian Information

Veterinarian's name *

Name of veterinarian clinic *

Clinic's phone number *

I hereby authorize the above names veterinarian to release requested information to a representative of Greyhound Pets of America-Charleston

Yes No Enter Your Initials *

References

Please provide a personal reference we may contact about your application

Reference Name *

Reference e-mail address

Reference telephone number *

Other

Where did you hear about us?

Is there any other information you would like us to consider?

Do you certify that all of the information on this application is true and correct?

Yes No Enter Your Initials *