Adoption Application form

Which dog are you interested in adopting? *

Your full Name *

email address *

Date *

How did you find out about our adoption program? *

Please tell us why you are interested in this PARTICULAR dog: *

Your age *

Your occupation *

Spouse's name

Spouse's occupation

Names and ages of children: *

Other occupants of home *

Home address *

City *

State *

ZIP

Home phone (no spaces) *

Mobile phone (no spaces)

Are you planning of having children

If so, when?

Does anyone in your household have allergies? *

If yes, describe:

Type of dwelling? *

Do you personally rent or own?

Months or years at this location?

If renting, do you have landlords permission to have a dog? *

Size or weight limitation? *

Landlord name and phone? *

Type of fencing *

Highest and lowest point of fencing *

Are there gates

Type of locks

If no locks, would you be willing to install them prior to placement? *

Do you have a swimming pool *

If yes, is the pool surrounded by a fence with gate? *

Who has access to your yard?

I have recently inspected my fences and they are all in good condition: *

The fence is intact on all sides and is at least 6 feet from the ground in all areas *

I promise to inspect my fences thoroughly before a home visit and make necessary repairs for the safety of our new pet

Primary reason for wanting a dog *

Do you have a pet now? *

How many *

How long have you owned this (es) pets

List type of pets, (if dog list breed), ages and sexes.

If you have children, please describe their previous experience with dogs. *

How many dogs live at, or are present at your residence and what is the breed of any such dog? *

Do any of your animals have any physical issues? *

Do any of your animals have behavioral issues? *

Do your animals get along with (other) dogs?

Have you ever had multiple dogs in your home?

How did you feed more than one dog?

Did you have toys and bones around? *

Are your pets spayed / neutered *

Have any of your previous pets had litters

Have you ever surrender an animal to a shelter or rescue group *

Is there anyone home during the day *

Who

About how many hours will the dog be left alone

Where will the dog stay when left home alone? *

When will the dog be inside *

Outside

Where will the dog sleep at night?

If inside, where exactly?

If you have additional comments on where the dog will sleep, please specify.

What rooms are off limits for the dog

What outside areas are available to the dog

if other, please specify.

Do you have a doggie door

Your preferred level of exercise with the dog.

How would you socialize the dog?

When you go on vacation, who will care for the dog?

Are you moving in the next 12 months?

Please explain.

What kind of food will you feed the dog?

Who will groom and feed the dog *

Would our dog wear a collar *

When? *

Do you have a regular Veterinary? *

Name of vet?

Would you like a referral to a vet?

How would you rate your level of dog owning experience? *

How would you train this dog? *

If other, please explain

How would you discipline your dog if he or she misbehaves? *

What, if any, behavioral issues have you dealt with in the past? *

Have you ever had any of your dogs get into a serious fight? *

If yes, please explain:

You normally walk your dog on a leash or off leash? *

What type of leash? *

If your dog escaped from your home, what steps would you take to find him or her? *

Are you willing to live with hair on the furniture, stains on your rugs, and an animal that might be destructive at times?

Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet? *

Are you able to make a long-term commitment to care for your pet for it's entire life span, which could be as much as 10 to 20 years? *

What would happen to your pet if you moved locally? *

Out of State? *

Out of country ? *

Are there any reasons that might prompt you to give up your dog? *

Please list pets you have owned since you have been an adult and the length of ownership *

If your present relationship where to change or there was a death in the family, where would the dog go? *

How did you find out about our adoption program?

Why are you interested in adopting from a rescue? *

I understand that a home visit is required prior to final placement?

I understand that a home visit does not guarantee placement? *

I can give a charitable contribution of $450: *

I agree to provide my own collar, leash, corrective collar or harness and a personal ID tag at time of completing the adoption contract! *

Loveleorescue reserves the right to refuse adoption to any applicant for any reason!

Any comments? *

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