Application

NEADS Furloughed Favorite

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  = Required Information

Personal Information

First Name
Last name
Street Address
City
State
Postal Code
Phone Number
Email
In case of emergency, name of a relative we can call if we could not reach you.
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Phone
Emergency Contact Relationship

Your Application

How did you hear about the NEADS Furloughed Favorite program?
Why do you want a Furloughed Favorite?
Who will be the dog's primary caretaker?
Please provide two personal references that we may contact.
Name
Relationship
Relationship Phone
Reference Email
Second Reference Contact Details
Name
Relationship
Relationship Phone
Reference Email

Living Arrangements

Living Environment?
Please describe your neighborhood (for example, busy road, neighbors close by, dogs/cats running)
Do you live in a one level or multi level home?
Do you own or rent?
Do you live in a house or apartment ?
Do you have a yard?
How many people live with you?
Please list below name, relationship and age of people living with you:
Do you have frequent visitors?
Do you or anyone in your household have a dog now?
Please list other pets (type, age, altered, friendly to dogs?)
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