First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone Number:
Have You Ever Had A Dog?	Yes No
When?	Please Select Now Within The Last Year Within The Last 3 Years
Do You Have Any Dogs Now?	Yes No
Breed(s) And Approximate Age(s):
How Much Time Will The Dog Spend Unattended Each Day?	Please Select 1 Hour 2 Hours 3 Hours 4 Hours 5 Hours 6 Hours 7 Hours 8 Hours 9 Hours 10 Hours 11 Hours 12 Hours More Than 12 Hours
What Is The Name Of Your Veterinarian?
What Is Your Veterinarians Phone Number?
Do You Have Any Other Types Of Pet In Your Home Now?	Yes No
What Kinds And How Long Have You Had Them?
Do You Have A Fenced In Yard?	Yes No
Do You Have Any Children?	Yes No
Please List The Names And Ages Of Any Other Family Members Living In Your Home:
Please Tell Us Why You Would Like To Adopt A Dog From Our Program:
Email Address:
Additional Comments:
Release And Disclaimer I/We, release The Gift of Sunshine, Inc., its Directors and members, from any and all liability for injuries or damages sustained by me/us as a result of my/our activities with The Gift of Sunshine, Inc. I am aware of the possible danger associated with these activities, and I/We, will take full responsibility for any accidents or injuries that may occur to me/us. I/We, further agree to indemnify and hold harmless The Gift of Sunshine, Inc. for any and all claims or demands made against it by reason of any action I/We might take. I/We futher certify that all of the information above is true and correct to the best of My/Our knowledge at tthe time that this form was completed, and also that I/We  are responsible for any changes that may affect the validity this form in the future.
My typed name below shall have the same force and effect as my written signature. Signed: