ADOPTION APPLICATION
Legacy Dog Rescue of Ohio
Name of the dog you are applying for:
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Please list the reason(s) you are interested in adopting this dog:
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Please list any questions or concerns you have about this dog:
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Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Email
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example@example.com
Your Age:
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Your Occupation:
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Spouse Name, Age & Occupation
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Are all adults currently living in this home in agreement on bringing a new dog into the home?
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Yes
No
Number of adults living in the household:
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1
2
3
4
5
Who are the adults living in the household (ie, wife, husband, mom, dad, grandparents, etc)?
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Number of children in the household?
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Please Select
0
1
2
3
4
5
List each child's age (ie, Lisa, 6 years, Ronnie, 9 years, etc):
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Please indicate your living environment (SELECT ONE):
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House
Apartment
Condo
Townhouse
Mobile Home
Other
Do you own or rent your home?
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Own
Rent
If you rent, you must provide the name and phone number of your landlord:
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If you rent, please provide amount of rental deposit, if any (write N/A if you own):
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How many hours will the dog be home alone on a typical day?
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Where will the dog stay in the home when alone on a typical day? ex: crate, loose inside home, outside or other, please explain:
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What major life changes do you possibly foresee in the next 10 years? Marriage, childbirth, health issues or other.
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Can you provide a permanent home for the duration of the dog's life?
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Is your yard securely fenced:
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Yes
No
If yes, what is the TYPE of fencing (Privacy, chain link, etc) and the height of the fence?
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Please list each current pet. List the NAME, AGE and TYPE. (IE, Duke, 10 years, Husky)
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Does your current dog eat Dry food, Wet food or Raw food?:
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Please Select
Dry
Wet / Canned
Raw
What brand of food do they eat?
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How many dogs have you owned in the past 15 years?
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If you no longer have these dogs, could you explain why (ex deceased, rehome, etc)?
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Are All current pets spayed or neutered?
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Yes
No
If not spayed or neutered - why?
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Do any of your Current or Previous pets live outdoors?
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Yes
No
Are your current/previous pets kept on Heartworm preventative?
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Please Select
Yes
No
Heartworm preventative - If yes, which one? If No, please explain why:
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Will you keep a dog that you would adopt from our rescue on Heartworm Preventative all year?
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Please Select
Yes
No
If you answered no to keeping an adopted dog on Heartworm Preventative all year, please explain.
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Where will dog sleep at night? (Crate, loose in house, outside or other, please explain):
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Have you ever surrendered a cat or dog to a pound/shelter?
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Please Select
Yes
No
If you have surrendered a cat or dog to a shelter/pound, please explain:
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In your opinion, which of the following circumstances might justify giving up your dog? Moving, new baby, divorce, escaping fence, behavioral problems, shedding, loss of interest, time consumption, allergies, size of dog, housebreaking, medical problems, aggression, unwanted chewing, not getting along with other pets or other, please explain:
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Have you ever worked with a dog trainer / training facility?
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Yes
No
If yes, which one:
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What was the reason you went?
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Was the training successful?
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Does your current dog(s) go off leash?
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Please Select
Yes
No
How did you train them to be off leash?
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Who will watch your pet while you are on vacation?
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If this dog is placed in your home and subsequently the adoption is finalized, do you agree that if you must later surrender this dog, you will only surrender to a representative of Legacy Dog Rescue of Ohio, Inc?
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Yes
No
Provide name, address and phone number of your current veterinarian. If you do not currently have one, please explain why. (Note: at time of placement a veterinarian practice in your area must be identified, that can provide full service, not just spay/neuter service).
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May we contact your veterinarian for a reference?
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Yes
No
As part of the adoption process, a home visit is required before or at the time of placement of the dog. Are you willing to permit a representative of Legacy Dog Rescue of Ohio, Inc to visit your home?
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Yes
No
Release - I accept the animal as is and assume all risk of ownership, including risk of injury or damage caused by the animal. On behalf of heirs, my personal representatives. assigns and myself, I hereby release Legacy Dog Rescue of Ohio, Inc , its directors, officers and agents from any and all claims, cause of action and demands of any nature, whether known or unknown, arising out of or in connection with my adoption. By signing and dating below, I attest that my answers were truthful to best of my knowledge. I understand falsification of any given information will be grounds for disallowing the adoption of a Legacy Dog Rescue of Ohio, Inc dog and likely removal of said dog from the home. I further state that I am 18 years of age or older and fully understand Legacy Dog Rescue of Ohio, Inc reserves the right to refuse any applicant without providing reason.
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Signature and Date
Submit
Should be Empty: