501 (c) 3
Tax ID # 37-1667471

P.O. Box 3511
Rocklin, CA 95677
Phone: 916-708-4549
Fax: 916-682-2269
Email: handsinc@frontier.com

Phone Number:
Number of current pets:
Number of children in the home:
Have you owned a dog before:
How many hours will you spend with your dog:
How much exercise per day can you give your dog:
How long will your dog be alone during the day:
Do you:
Do you have a current veterinarian:
Type of housing:
Do you have a fenced yard:
What is your preferred level of exercise with the dog:
Do you prefer:
When your away how to you plan to keep your pet:
Will you be taking your dog to training:
Why do you wish to adopt this pet? Check all that apply:
Ages of your children:
How did you hear about us?:
Pet size preference:
Are your current pets Spayed or Neutered:
Do you plan on getting pet insurance:
Who will primarily be responsible for pet care:
Please tell us which puppy you would perfer:


For security, each spinning column above will briefly pause on a letter. Please enter the letter displayed in the corresponding box below the column. The letters do not have to be capitalized.