Dog Adoption Application

* Indicates required field

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone *

Work Phone *

Cell Phone *

How did you hear about us (Facebook, our website, Adopt a Pet, Petfinder, etc.)? *

1. What type of dog are you interested in?

Gender *

Male Female Any gender

Age *

Puppy (under 5 months) Adult Any age

Hair length *

Long Hair Short Hair Any hair length

Personality type *

Color *

Name of dog you are interested in *

2. How many people currently reside in your household? *

3. Any children in the household? *

Yes No

Children's Ages? *

4. Does any member of the family have any allergies to animals? *

Yes No

If yes, explain *

5. Who will be responsible for the dog’s care? *

7. Do you own or rent your residence? *

Own Rent

If you rent:

Landlord's name *

Landlord's Phone Number *

8. Are animals allowed? *

Yes No Not sure

9. Will the dog be indoor, outdoor, or both? *

Indoor Outdoor Both

10. Will anyone be home during the day? *

Yes No

11. How many hours will the dog be left alone? *

12. When no one is home, where will the dog be kept? *

13. Where will the dog sleep? *

14. If you move, what will you do with the dog? *

15. Have you ever had an animal before? *

Yes No

16. Describe those animals you still care for or that are living in your household.

Name *

Breed *

Age *

Spayed/Neutered? *

Kept where? *

Time in your care *

Name *

Breed *

Age *

Spayed/Neutered? *

Kept where? *

Time in your care *

Name *

Breed *

Age *

Spayed/Neutered? *

Kept where? *

Time in your care *

If you live with or care for more than three animals, describe the rest here. *

17. Describe those animals you no longer care for.

Name *

Breed *

Age *

Spayed/Neutered? *

Time in your care? *

Reason no longer with you *

Name *

Breed *

Age *

Spayed/Neutered? *

Time in your care? *

Reason no longer with you *

Name *

Breed *

Age *

Spayed/Neutered? *

Time in your care? *

Reason no longer with you *

18. Are your animals current on their vaccinations? *

Yes No

19. Please provide your current veterinarian's name *

Veterinarian's phone *

20. Are you financially able and willing to provide annual checkups, vaccinations, and ANY medical care necessary? *

Yes No

21. What precautions would you take to properly introduce a new dog into your home if you have other animals (dog, bird, rabbit, another cat, etc.) *

22. What will you do if your new dog does not get along with your present animals? *

23. Are you planning on debarking or docking ears or tail?? *

Yes No Not sure

24. Why do you want to adopt a dog? *

25. If a disciplinary or behavior problem arises, what steps will you take to work on it? *

26. Are you familiar with your local animal control laws? *

Yes No

27. Are you willing to sign legal pet adoption papers? *

Yes No

28. Do you agree to permit a visit to your home at time of delivery by appointment? *

Yes No

Do you agree to the following: By signing this form, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Lifeline for Pets refusing adoption privileges to me/us. If my/our request for adoption is approved and later Lifeline for Pets discovers the above information is not true or correct, Lifeline for Pets reserves the right to remove the adopted dog from my home. *

Yes, I agree. No, I do not agree.

Do you have any additional questions or comments? *

Dog Adoption Application

If you'd like to adopt a dog, please fill out this form or pick one up at one of our adoption events.