Your full legal Name (Required): Birthday (Required - Format MM/DD/YY):

Street Address(Required):

City(Required): State(Required):

Zip(Required):

Phone(Required): Email Address (Required):

Best time frame to contact you(Required):

Do you have experience with Pit Bulls? (Required): Select Yes No

Do you own or rent your home? (Required): Select Own Rent

If you rent, is your landlord okay with you taking in a Pit Bull as a foster?: Select Yes No

If you own, does your home insurance company cover Pit Bulls (some black list breeds)? (Note: Farmers and State Farm have no such restrictions).: Select Yes No

What type of dog will best integrate into your household?

What age group? (Required): Select Adult Puppy Either

What gender? (Required): Select Male Female Either

How it relates to other dogs (do you need a dog that gets along with all other dogs, big and small, or can you take a dog that gets along with males or females? Or can you take a dog that doesn't get along with other dogs)?(Required):

Do you need a dog that is Cat safe? (Do you have cats or small animals and need a dog that is good with small animals/cats)?(Required): Select Yes No

Do you need a dog that is Children safe (do you have children in your household and need a dog that doesn't jump, etc.?)(Required): Select Yes No

Describe any other characteristics of a candidate dog that will help us match a dog to your household.:

Are you able to supply food for the dog? What expenses are you wanting Chako to cover (food? toys?). We normally cover vet expenses, of course, unless you prefer to donate them.:

Do you have time to meet with potential adopters and let them interact with the dog?:

Do you have time to take the dog to spay/neuter appointments and/or help set up around your schedule?:

What current animals do you have in your home?:

What people reside in your home?:

Do you have any ability to train the dog with basic obedience (sit, down, etc.)?:

Is there anything else we should know that would help us evaluate you and make a match?:

What days/times are you available for us to come to your home to meet with you?:

Have you volunteered with other animal organizations? (Required): Select Yes No

If so, which one(s) (If so, required):

Please provide any other comments you would like to share. (Optional):