Gentle Touch Animal Sanctuary
Rescue and Placement Service
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Dog Application

Contact Information

Please fill out the form below and hit the submit button when completed.  An adoption assistant will respond shortly.

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Evening Phone:
Best time to contact you:
List two personal references, name, phone number and relationship to you:
How many dogs do you have?:
Their ages:
Do you dogs get along with other dogs?:
Do you have children?:
Ages of your children:
Have they been around dogs?:
Do you have cats?:
How many?:
Their ages:
Do they get along with dogs?:
Number of adults living in the home:
Do you own or rent?:
If you rent do you have your landlord's permission to have animals:
Landlord's name and phone number:
Please specify what type of dwelling you live in, apt, house, townhouse, etc:
Is anyone in your home allergic to dogs?:
How will your new dog spend its days, please specify; Indoors, outdoors, basement, garage, porch, barn, crated, etc:
How will your new dog spend its night, please specify from list above:
Would you agree to a home visit:
Please list your Vet's name, address, and phone number:
Please list your birthdate (for background check):