Family Profile Form

Purpose*

Please choose why you are submitting this form

I would like to adopt a NeoRescue Inc. Dog

I would like to foster a NeoRescue Inc. Dog

I would like to volunteer for NeoRescue Inc.

Your Information

First Name*

Last Name*

E-mail Address*

Street Address*

Street Address (cont'd)

City*

State*

Zip Code*

Home Phone*

Work Phone

Other Phone

Household

Names, relation, and ages of other people in the household

Are there other adults in the house?*

Yes No

Please list the names & ages of other adults in the house*

Are there children in the house?*

Yes No

If you answered 'yes' above, are any of these children under 12?

Yes No

Please list the names & ages of any children in the house

Information about your current veterinarian (if any)

Current Vet's Name

Vet's Street Address

Vet's Phone Number

Dwelling Information*

Do you own or rent your dwelling?

Own

Rent

Other

In what kind of dwelling do you reside?*

Detached House

Townhouse or other multiunit dwelling (i.e. Condominium)

Apartment

Mobile Home

Other

Pet Information

Do you currently have any other pets?*

Yes No

If any of those pets are dogs, are they all spayed/ neutered?

Yes No

If you answered "yes" to the above question, please describe your pets. Please be sure to include the following info: Pet Name, Pet Type, Pet Age, Pet Sex:

Will the dog you adopt live primarily inside or outside?

Inside Outside

If you have a yard, is it fenced?

Yes

No

N/A

Please describe the approximate size of your yard and the type of fencing (if applicable). Note: a fenced yard is mandatory unless approved by the rescue committee

If the dog will stay outside during the day, please describe the shelter it will have

Have you ever owned a dog?

No

Yes - as a child

Yes - as an adult

If you answered "Yes" above, what kind of dog?

Please describe when you had those dogs and, if you no longer have them, what happened to it/ them?

Please explain why you would like to adopt a Neapolitan Mastiff

Personal Reference Information

(please supply names and telephone numbers for 3 personal references)

Reference #1*

Reference #2*

Reference #3*

Additional Information

Is there any other information you feel may be important for us to know when determining the best Neapolitan Mastiff to match with you and your family?

Is there a particular NeoRescue Inc. dog that you are interested in?

Is there a particular NeoRescue Inc. Volunteer that you have been in contact with?

Signature*