Pet Adoption Application Form

Prospective Pet Parent*

First NameLast Name

Name of Pet You Wish to Adopt*

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?*

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Please provide your veterinarian's name and phone number:

What is your home type?

HouseApartmentCondo/TownhomeOther

Do you own or rent your home?*

OwnRent

Please note that if you rent, we require owner/landlord/complex consent indicating approval to own dog on property.

How long have you lived at this address?*

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? please describe

What is your landlord's pet policy?*

If you rent, please provide your landlord's information here:*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

How many adults live in the home?*

Are there children in the home? (If yes, please list ages)*

If you answered "Yes" to the above question, please provide detail:

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

Please provide the names, emails, and contact numbers for 2 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

Please fill out any additional information or comments here.

By clicking submit, adopter acknowledges that Canine Lighthouse does not adopt on a first come first served basis. We work diligently to find the best match for the pets in our care.
By clicking the submit button, I agree to the Canine Lighthouse Inc. adoption process, will undergo a homecheck and interview.
By clicking the submit button, I understand Canine Lighthouse Inc. will check my references.
By clicking the submit button, I understand there is an adoption donation associated with adoption and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation is not refundable and will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Canine Lighthouse Inc. BY EMAIL and provide a 14 day period to allow arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Canine Lighthouse Inc. against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Canine Lighthouse Inc. will disclose any of the pet's health or behavior issues known by the before adoption is completed. Canine Lighthouse Inc. makes no explicit or implicit guarantees in reference to health and/or temperament of pet. Pet is placed "as is" and adopter assumes all responsibility for treatment of any and all existing and future conditions whether medical or behavioral. Canine Lighthouse Inc. is not liable for any medical bills or other bills that occur as a result of taking this pet into your home.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Canine Lighthouse Inc. and provide transport to where Canine Lighthouse Inc. deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*

Adoption Application, Contract & Waiver