Dog Adoption Matchmaker Dog Adoption Application Please fill out this form and an Adoption Specialist will be in touch with you shortly. Date Name or ID# of the dog you are interested in:*Is the pet you are interested in currently in foster care?YesNoN/AIf so, who is the foster parent and are they an Adoption Ambassador?My InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home/Cell Phone*Work PhoneAdditional Phone NumberCity/County of residence:*AlbemarleCharlottesvilleOtherAbout My HomeHow many adults are in your home?*How many children live in your home? Please include their ages.*Is anyone in your home allergic to pets?*Yes, dogs & catsYes, cats onlyYes, dogs onlyNoPlease tell us about your home.*I own my homeI rent my homeI live with my parents/relativesI live in college housingIf you rent, name and phone number of apartment complex or landlord:Tell us about your furry friends!Please list all pets on your household:List the type of animal (cat, dog, etc.) and include each animal's age, sex, if the animal is spayed/neutered, and where they are kept (indoors, outdoors, or both)If you've owned pets in the past, please list below.Do you currently have a veterinarian?*YesNoIf yes, what is their name?Are your pets current on their vaccinations?YesNoMy PreferencesI am looking for:PuppyYoung adultAdultSeniorNo preferenceAt its adult size, my ideal dog would be:Small (5-25 pounds)Medium (25-50 pounds)Large (50-80 pounds)Extra large (80 pounds and over)No preferenceWould you like a:*MaleFemaleNo preferencePlease choose the energy level you are looking for:LowMediumHighPlease check what is necessary to you in a dog that you would adopt: Housetrained Rarely barks Doesn't chew Good with strangers Running companion Gentle with young children Good with other dogs Good with cats Other If other, please explain:Where will your dog be kept?*Primarily indoorsIndoors and outdoorsOutdoors onlyHow many hours a day will your dog be left alone? How will he be confined?Where will he sleep at night?How do you plan to exercise your pet?