PLEASE NOTE:  WE DO NOT SHIP DOGS AND PREFER TO PLACE DOGS WITHIN ONE HOUR OF SECAUCUS, NJ OR POUGHKEEPSIE, NY. 
Since the rescue dog has already been separated  from a home, we try to match the dog up with the applicant that can best meet a particular dog's needs to ensure a permanent home.  If you are not willing to undertake some basic housetraining, DO NOT apply to this rescue organization.  Due to the volume of applications, we cannot answer individual emails.  Thank you for considering a rescue animal.

Name of dog (if specific dog) you are applying for:
Name:
Email:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Age:
Occupation:
Employer:
If adult applying does not work outside of the home, please provide partner's
employer:
Would you consider a dog that is not housebroken? yes no
What age dog would you prefer? 0-4 (rarely available) 5-8 8-12 12+
Would you consider a dog that is over 8 years of age:
What sex would you prefer: Male Female
Would you consider the opposite sex?
Would you consider a dog between 19-25 lbs:
Would you consider a dog that may have "special needs":
Number of adults in household:
Number of children:
Ages of children:
Number of household dogs:
Breed/Gender/Neutered/Ages:
Number of household cats:
Breed/Gender/Neuterd/Ages:
Other Animals:
Times/Hours Adult Work on Weekdays: 0-3 3-5 5-8 8-12
Times/Hours Adult at Home on Weekend: 0-3 3-5 5-8 8-12
Average number of hours dog will be alone: 0-3 4-6 6-8 8-12
Where will the dog stay during the day:
Where will the dog stay at night:
Where will the dog stay when you travel out of town:
What are your thoughts on the use of a crate for your dog:
Your home is a House/Condo/apartment: Own Home Condo Apartment/Rental
Rental Manager's name and phone number:
Is your yard fenced:
What is your time frame for obtaining a dog:
Estimate your expected monthly grooming expenses:
Estimate your expected annual vet care expenses:
Current Veterinarian Name:
Address and phone number:
Are you prepared to make a donation for a Rescue that will generally range from $200 to $300 dollars:
Are you willing to take your dog to obedience training:
Why do you want a dog at this point in your life:
Would you be willing to foster a dog:
DUE TO THE NUMBER OF INQUIRIES WE RECEIVE, we are not able to answer each one individually.  If we feel you may be a match for one of our dogs, WE WILL CONTACT YOU. 

Anything else you would like to tell us: