If you own, the following must be completed:

If you Rent, please complete the following

IMPORTANT: Many homeowner's insurance companies have breed blacklists which include, but are not limited to, pit bulls, American Pit Bull Terriers, American Staffordshire Terriers, Staffordshire Bull Terriers, Rottweilers, Dobermans, Akitas, American Bulldogs, Chows and wolf-hybrids and will not insure you if they reside in your home or may cancel your insurance if you add a dog of these breeds to your home. Please check your homeowner's insurance policy regarding breed discrimination before submitting this application to adopt a pit bull type dog. Landlords may also have these same breed restrictions due to their insurance policies. Please check this out before applying to adopt or foster one of these breeds.

Current Household
Veterinary Info

If you currently do not have any animals or recently moved to the area, please fill in with the Vet you would use or N/A and we can help suggest a vet office that we recommend in your area.

Additional Info

Please list out the NameAddress, and Phone Number of each reference you would like to submit. References should be non-related adults who do not live in your home. Please make sure you fill this out for a minimum of two references.


Please type in the reCaptcha info below in the box. You should see a photograph or graphic with a string of characters that must be entered into the box before you can hit submit.