Full Name

Street Address

Address Line 2

City

State

Zip Code

Primary Phone

Other Phone

Email Address

Number of Adults in Household:

Number of Children:

(if applicable) Ages of children:

Type of Dwelling (House, Apt., etc.)

Rent

Own

If renting, can you get your Landlord's permission to adopt?

Yes

No

If renting, Landlord's Name:

Phone Number:

Do you have a fenced yard?  Yes

No

If no fences, are you willing to walk your greyhound 4-6 times per day?

Yes

No

Yes

No

If so, what breed(s), and what became of the dog(s)?

Yes

No

If "Yes", please list:

Yes

No

If "Yes", Vet's Name:

Vet's Phone Number:

What do you want in a Greyhound? (Age, gender, color, size):

Reference #1) Name:

Phone Number:

Reference #2) Name:

Phone Number:

Reference #3) Name:

Phone Number:

During the first year, are you willing to let someone from Queen City Greyhounds come to your home to check on the Greyhound?

Do you understand that Queen City Greyhounds determines that the dog is not being cared for adequately, we may repossess the dog?

Once you take custody, do you agree to take full financial responsibility for the dog?

Do you promise to keep your Greyhound solely as a house pet and not to use him for racing, research experiments or hunting?

Do you promise to return your dog to Queen City Greyhounds if for any reason you can no longer keep your dog?

Do you agree that the Greyhound can NEVER be tied out on a chain or rope?

How did you hear about QCG?

Signature

Have you owned a dog before?

Do you have any other pets?

Do you have a veterinarian?

Would you consider a substitute?

Would you consider a senior grey? (Age 5+)

Yes

No

Yes

No

Please list three references who do not live with you and are not related to you. These references will be contacted by a QCG Representative

Checking the following boxes signifies you agree to the following stipulations:

Date