* required information

1a) *Name:

1b) *Employer:

2a) *Work Phone (include area code): *Job Title:

2b) *Number Years:

3) Spouse/Partner:

Employer:

4) Work Phone: Job Title:

Number Years:

5a) *Home Address:

5b) *City:   *State: *Zip:  

6) E-mail Address:    May we contact you via email  Yes No

7) *Home Phone (include area code): Cell Phone:  

*Number Children:   Ages:

Any other people living in your home?

8) *Do you own your residence? - Yes No N/A  

9) *Do you lease your residence? - Yes No N/A

10) If so, do you have permission from your landlord and/or does your lease allow you to have a dog up to 80 pounds? - Yes No N/A

11) Landlord's Name   Phone number:

• *12) Do you agree to keep your greyhound exclusively as a house pet and agree NEVER to use it for breeding, racing or coursing for money, hunting, or laboratory research? - Yes No
   
• *13) Your greyhound is currently on heartworm preventative.  Do you agree to keep your greyhound on heartworm preventative? - Yes No

• *14) Do you agree to notify GPA if for any reason you find you cannot keep your greyhound and further agree that you will NOT give or sell the greyhound to anyone else? - I will not sell/giveaway dog I will NOT agree to this.

• *15) Do you agree to keep a collar and a GPA I.D. tag on your greyhound with proper I.D.
  AT ALL TIMES? - Yes No

• *16) Do you agree to notify GPA immediately should your greyhound ever become lost or stolen? - Yes No

• *17) Once a year a questionnaire is mailed to all adopters. 
  Do you agree to complete the questionnaire informing GPA as to how your greyhound is doing? - Yes No

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Please provide us with your Vet's information:

18) *Name:   19) *Phone:

20) *Address:

Name and phone number of two friends or relatives we may contact for information, references or in case of an emergency

21a) *Name1: 21b) *Phone:

21c) *Name2: 22d) *Phone:

37) List the previous pets you have owned:

38) Do you want a Greyhound for a (mark all that apply):

39) What do you consider valid reasons for giving up your Greyhound? (mark all that apply):