Adoption Application

Jazzy's Legacy Inc. Adoption Application
Which Rescue dog are you interested in adopting? (Name) *
First & Second Choices
If selected dog is unavailable can we match you with another? (Check all that apply)

FemaleMaleEither Male/FemaleYoungerOlderAny age
Are you willing to work with us to correct any possible behavior issues that your adopted dog may have?*

YesNo
Do you have a trainer that you would use if needed? Yes / No (If Yes / Provide Information)
Adopter Personal Information
Name*

First NameLast Name
Date of Birth? *
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
Yourself & Family
Please fill out the entire application. All questions marked with a ( * ) are required and they must be answered. If they are not, the application will not submit. If any of those marked required do not pertain to you, mark (N/A) in order to move forward with the application process.
List the Names & Ages of any additional (Adult) family members or those who live in your home.
List the Names, Ages and Relationship to you of any Children under the age of 18 who live with you or who visit your home on a regular basis.
List the Employers, Occupations & Hours of Everyone who lives in your home? *
Home Environment
Do you Own or Rent your home?*

OwnRentOther
Choose which best describes your living situation.*

HouseCondoApartmentModular Home
If a Rental, does your lease permit you to have animals?*

YESNOYES/ LIMITEDN/A
If living in an apartment / condo are there any restrictions on dog ownership or Breed? (Explain)*
Landlords Name:

First NameLast Name
Landlord's Phone #
Format: (000) 000-0000.
Do you have a fenced in yard?*

YESNO
If Yes, Please describe in detail including the Type & Height of fence and any Security measures taken to prevent animals from escaping or being harmed by predators.
Please be specific with your description.
IF No, Please describe how you plan to exercise the rescue animal ?
Rescue Animal Living Space & Care

This is important information, Please be Specific.
How many hours per day will your Rescue dog be left alone?*

1 -22 -44 -66 - 88 - moreNone
Please describe in Detail what the Rescue dog's living situation will be. (Please give a detailed description including hours when no one will be home.)*
Please be very Specific with your answer .
Current & Previous Pets

Including Vet Care
Have you had rescue dogs previously?*

YesNo
Where did you get them, where they are now and if rehomed, why?
Please be specific
Other animals living in your home? (Click all that apply)*

DogsCatsCaged AnimalsNone
Are your pets currently UTD on Vaccinations?

YesNoSome not All
Are your pets on Heart-worm and Flea Preventative?

YesNoNot right nowThey will be
Are your pets Spayed or Neutered?

YesNoNot YetSome not All
List ALL family Pets/ Include the Following: (Type / Breed / Age / Dates of last Vet. appointment & Vaccinations, Heart-worm, Flea meds. & Spay/Neuter dates)
Have any of your pets Ever displayed any Food or other aggression's toward other animals or humans?

YesNo
If so, Please give a detailed description. (Include: Date of any bite incidents)
List all Previous pets that you've owned in the past 5 yrs. (Include: Years owned & where they are now. *
Vets & Personal References
Name & Address of Past or Current Vet*

Name

Street Address Line

CityState

Zip Code
Phone Number*
Format: (000) 000-0000.
Thank you for your interest in adopting one of our rescue dogs. Please understand that we limit adoptions to Northern California, and we do not place dogs as gifts. We will not adopt a dog to a person who has not met the dog. The person with whom the dog will live must meet the dog and sign our adoption contract.

By signing below, I certify that, to the best of my knowledge, the information provided by me is true and complete. I recognize that any misrepresentation of that information will result in my losing the privilege of adopting a rescued dog. I understand that Jazzy’s Legacy Inc. has the right to deny my request to adopt one of their dogs, and I authorize checking of all information provided by this application.
Please sign below: *

Type your full name as entered above
Date*

MonthDayYear
Date
Should be Empty:

Jazzy's Legacy Inc. Adoption Application

Adopter Personal Information

Yourself & Family

Home Environment

Rescue Animal Living Space & Care

Current & Previous Pets

Vets & Personal References