Love-A-Stray Adoption Application

Non-Profit 501(C) 3, No-Kill Animal Rescue

Donation/Adoption Fee is Tax Deductible Adoption fee includes all vetting, spay/neuter, heartworm test, de-worming, all required vaccinations and microchip. Revised 6-1-15

WWW.LOVEASTRAYDOG.COM
Dog/Puppy Application

Thank you for your interest in a rescue dog. We appreciate your answers to the following questions so that we can make the best possible match for you, your family, your lifestyle and the dog. It is very important that we find the correct home for each dog. All information will be treated as confidential. Submitting an application does not guarantee that you will receive a dog. Please make sure all questions are answered. If the question is not applicable, just answer N/A.
Date:

- Month - Day Year
Full name: *

First Name Last Name
E-mail: *

Address:

Street Address

City	State / Province
Postal / Zip Code	Country

Do you live within a 45 mile radius of Avon Lake, Ohio?
City or County breed restrictions?
If "Yes", please explain:
Home phone number:

- Area Code Phone Number
Cell phone number:

- Area Code Phone Number
Work phone number:

- Area Code Phone Number
How did you hear of Love-A-Stray?
Residence type?
If renting, does landlord allow dogs?

Yes No
If renting, name of landlord:
Landlord phone number:
Are you 23 years or older? (minimum age requirement for adoption)
Please list all names and ages of members of household, including yourself: *
Anyone in home have allergies?

Yes No
If yes, please indicate allergy:
Type of fence:
If other fence, please explain:
Exercise you will provide if no fence:
Name of dog interested in adopting? *
Who made the decision to adopt a dog?
In your search for a companion pet, what has led to your decision to adopt the breed mix you are applying for?
Activity level you were looking for?
Will you take dog to obedience classes?
Are you willing to pay for a minimum of 2 training sessions (approximately $50 per 1 hour session) with recommended trainer to ensure the rescue dog gets a great start in his/her new environment?
Ability to work on house training?
Current # of pets residing with you:
Name of pet, description, breed, indicate if up to date on vaccinations, spayed/neutered?
Number of pets you've had in the last 5 years?
Where are those pets now?
Name of veterinarian:
Phone # of veterinarian:

- Area Code Phone Number
PLEASE CONTACT YOUR VET TO LET THEM KNOW WE WILL BE CALLING. WITHOUT CONSENT, YOUR VET CANNOT RELEASE INFORMATION TO US. THANK YOU!
Name of 1st reference:
Phone # of 1st reference:

- Area Code Phone Number
Name of 2nd reference (only needed if no veterinarian):
Phone # of 2nd reference

- Area Code Phone Number
Do you object to a home visit?
Reasons you would give up a pet?
Ever given a pet away?

Yes No
If yes, please explain:
Ever apply for a rescue pet?

Yes No
If yes, name of rescue(s):
Did you adopt from them?

Yes No
If no, please explain why:
Name of person caring for dog?
Work full time?

Yes No Work part time
If so, hours a day the dog will be alone?
Where will the dog be kept when home alone? (Please be specific)
If gone 8 or more hours a day, can someone come in mid-day to let dog out?

Yes No
Who?
Where will this dog be kept during the daytime? (Please be specific)
Where will this dog be at night? (Please be specific)
Is it ok to leave your dog outside alone?
Percentage of time dog will be kept outdoors alone:
Do you have a vacation planned in the next five (5) weeks?
Arrangements for dog when you are out of town:
"Digital Signature", please initial here: *
Thank you for looking into a rescue dog!
Should be Empty:

Dog/Puppy Application

Thank you for looking into a rescue dog!