Dog Adoption Application
Name(s)
Home Phone
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
E-Mail Address
example@example.com
Date of Birth
/
Month
/
Day
Year
Date
Occupation
Work Phone
Employer
Marital Status
Spouse's name
Spouse's employer
Do you have children? Names and ages
Other individuals living in household, names and ages
Does anyone have allergies or asthma that would be aggravated by a pet?
Please Select
Yes
No
Have you ever owned a pet tbefore? What kind?
What happened to your previous pet(s)?
Any other pet(s)? Type, breed, age, gender.
Are they spayed or neutered?
Please Select
Yes
No
Current on vaccinations?
Please Select
Yes
No
Heartworm preventative?
Please Select
Yes
No
Is/was your dog licensed?
Please Select
Yes
No
What town?
What other shelters or rescue groups have you visited or applied to?
Who is your past or present veterinarian?
Do you rent or own?
Name and number of landlord
Have you discussed adopting with your landlord?
Do you have a yard?
Is the yard fenced?
What type of fence and how high?
Where will the dog stay during the day?
At night?
Will the dog be with someone during the day?
Have you discussed adoption with your family?
Is everyone in agreement about adopting?
Please Select
Yes
No
Would you be willing to take your new dog through a basic obedience course?
Please Select
Yes
No
Name or type of dog(s) you are interested in.
Signature
Date
/
Month
/
Day
Year
Date
LA Pets Alive, Inc.
(310) 663-6013
.
lapetsalive@gmail.com
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