Furloughed Favorite Application NEADS Furloughed Favorite Application Personal Information First Name Last Name Street Address City StatePlease select... AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA MA ME MD MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS DC FM GU MH MP PW PR VI Zip Code Cell Phone Number Home Phone Number Email Your Application How did you hear about the NEADS Furloughed Favorites program? Why do you want a Furloughed favorite? Living Arrangements Who will be the dog's primary caretaker? Do you live in a city, suburb, or rural environment?Please select... City Suburb Rural Do you own or rent?Please select... Own Rent Have you discussed this application with your landlord?Please select... Yes No Do you have written permission from your landlord to own a dog?Please select... Yes No Landlord's Name Landlord's Phone Do you live in a house or apartment?Please select... House Apartment Do you have a yard?Please select... Yes No Is your yard fenced?Please select... Yes No Does the fence encircle the yard completely?Please select... No Yes What is the height of the fence? What is the material of the fence? Household Members and Pets How many people do you live with?Please select... 0 1 2 3 4 5 or more Are there any members who live there part-time?Please select... Yes No If yes, how many?Please select... 0 1 2 3 4 5 or more Please list below name, relationship, and age of people living with you. If you have children, do they have experience with dogs? Do you have frequent visitors?Please select... No Yes Do you or anyone in your household have a dog now?Please select... Yes No If so, what is the breed and age of the dog(s)? Please list for each dog breed, age, male/female? spayed/neutered? friendly to other dogs? Please list other pets (type, age, spay/neutered, friendly to dogs?): If you have cats, are they comfortable with dogs?Please select... No Yes Lifestyle How frequently do you travel?Please select... Once a month Once every 6 months Once a year None Would you take your dog with you on trips?Please select... Yes No Do you plan to use this dog as a therapy dog for yourself or others?Please select... Yes No What are your hobbies/interests? Dog Care Have you ever had a dog before?Please select... Yes No If so, what breed(s) and when? What happened to the dog(s)? Have you ever sold, given away, or surrendered a pet?Please select... Yes No If so, why? Have you ever used pet care services?Please select... Yes No If so, please explain: How often would you leash walk your dog? How many hours per day would the dog be alone? Please enter a single digit (i.e. 4). What activities are you planning on doing with your dog? Where will your dog be kept during the day? Where will your dog be kept at night? Where will your dog be taken for toilet requirements? Where will your dog be taken to be exercised and have play time? Would you let your dog run free outside of an enclosure?Please select... Yes No Are you familiar with crate training?Please select... Yes No Do you plan on using a crate with your dog?Please select... Yes No Are you willing or planning to attend a training class with your new dog?Please select... Yes No Veterinarian Contact Information Name of veterinarian: Veterinarian phone number: Veterinarian address: Do we have your permission to contact your veterinarian?YesNo Please review the information you have provided. You will not be given the opportunity to edit this information after you click the submit button.