Dream Dog Application

ACTS - Assistance Canine Training Services
2928 East Conway Road
Center Conway, NH 03813
603-383-2073

IMPORTANT INSTRUCTIONS: Please read carefully

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You must fill out this entire form in one session. If you leave your form will NOT be saved.

Our Dream Dogs are named after Skye, our first released dog who with the help of the Make a Wish Foundation went to a young boy with kidney cancer. We believe all our dogs, graduates or released dogs, have a job to do and a story to tell.

Please take the time to tell us your story when filling out this application form.

If you are chosen for one of our Dream Dogs, your story will become your dogs story! Help us fit the pieces together by taking some time to let us get to know you.

Our dogs are not placed in order of application receipt. They are matched with the best home.

Date*

Date

Name*

First NameLast Name

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home/Shipping Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone*

Area CodePhone Number

Home Phone

Area CodePhone Number

Work Phone

Area CodePhone Number

Email*

example@example.com

I am applying for*

A Dream Dog - An older released dog that has some trainingA Puppy - 8 - 12 week old, occasionally availableEither a Dream Dog or a puppy

How many people live in your home and what are their ages?*

Is everyone in the household in agreement with this adoption?*

Does anyone on the household have allergies to dogs?*

Do you currently have a dog? If so, what breeds, sex, and ages?*

Do you currently administer or plan on administering monthly heartworm prevention?*

Do you currently administer or plan on administering monthly flea and tick prevention?*

Do you currently vaccinate or plan on vaccinating your dog/s?*

With any of your current dogs or past dogs, what brand of dog food have you fed?*

If you currently own a dog: Should something happen to you making you unable to care for or keep your dogs, have you made arrangements for who will care for your dog or dogs? Are your dog/s or any other pets accounted for in your will?*

Have you had dogs in the past? If so what breeds and what happened to them? *

If you currently do not own a dog but have owned a dog in the past, how long has it been since you owned a dog?*

What breed or breeds of dog are you interested in?*

Is there a breed or sex of dog that you would NOT consider?*

Do you have a cat?*

Do you have other pets? If so what?*

How many hours a day will the dog be home alone?*

Where will the dog be kept when it is alone?*

How energetic can the dog be?*

How will you exercise the dog?*

Do you have a fenced in yard? *

Do you have a dog run?*

Would the dog be allowed to run free?*

Are you or anyone in your house smokers? If yes, do they smoke int he house or car?*

Please give any other additional information that we might find useful in processing this application.

REFERENCES

Your references should help us decide if you have the character we require to receie one of our dogs. You should select people who are NOT your immediate family. References who can specifically speak to you as a dog owner are particularly helpful

First Reference

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Relationship to Applicant*

2nd Reference

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Relationship to Applicant*

3rd Reference

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Relationship to Applicant*

How did you hear about ACTS?*

Conditions

· I understand that the completion of this application for a Dream Dog is no guarantee that there will be a match for me or that a dog will be offered to me in any guarantee period of time.

· I understand that I may refuse any dog offered to me and that I will still remain on the list, and thus refusing a dog does not in any way affect my chances for another dog.

· I understand that the ACTS dogs are released from the program anywhere between the ages of 2 months and 2 years and that they are released for a number of reasons including heath and behavior issues.

· I understand that ACTS will disclose these reasons to the best of their abilities for my consideration.

· I understand that owning a dog is a lengthy commitment and I am fully aware of the related expenses including food, veterinary care, and possibly grooming.

· I understand that the adoption fees for a Dream Dog range from $4,000 - $7,000 and that these fees are subject to change at any time.

ACTS is a 501(c)(3) non-profit

I acknowledge that by submitting my name and signing below, that all the above information is accurate.

Name*

First NameLast Name

Please Sign and Submit*

When you click the SUBMIT button, the final version of this form will be sent to ACTS.