2. Name (First, Last Name)*
4. Email*
6. Date of birth*
8. Home address *
10. City*
12. Zip code*
14. Phone #*
16. [Space]
18. Have you filled out a pre-adoption form?*

    1. No [If No, you will be asked to fill out a pre-adoption form]
    2. Yes
20. [Space]
22. What breed are you interested in adopting? Please be specific to help us provide the best match for you.*

    1. Dachshund
    2. Maltese
    3. Shih Tzu
    4. Yorkshire Terrier
    5. Chihuahua
    6. Great Dane
    7. Golden Retriever
    8. Cane Corso
    9. Boxer
    10. Other
24. If other, please specify.
26. Would you consider a dog that is special needs?*

    1. Yes
    2. No
28. Would you consider a dog with separation anxiety?*

    1. Yes
    2. No
30. Would you consider a dog that needs to be the only dog or pet?*

    1. Yes
    2. No
32. Would you consider a dog that cannot be with young children?*

    1. Yes
    2. No
34. Would you consider a dog that has to be supervised outside?*

    1. Yes
    2. No
36. *If you consider any of these the shelter can help educate you on the above*
38. Which gender would you prefer?*

    1. Female
    2. Male
    3. Either
40. Are there any weight limitations?*

    1. Under 25lbs
    2. Under 50lbs
    3. Other
    4. None
42. If other, what weight limitations do you have?
44. What age range are you looking for?*

    1. 2 months - 6 months
    2. 6 months - 1.5 years
    3. 1.5 years - 3 years
    4. 3+ years
    5. Senior
46. Is there any additional information we should know? (i.e. good with kids, housetrained, etc)*
48. The staff of Tri-City tries their best to call our citizens with pet requests when the animals come in, however we are not always able to do so. It is best to still come in on your own and to keep an eye on our website, www.luvpets.org.
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