Leashes of Love Adoption Application

Leashes of Love Adoption Application
Full name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone number*

Area CodePhone Number
Employer
Employers address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Work number

Area CodePhone Number
Which dog or dogs are you interested in?*
Why did you select this dog(s)?*
Where did you hear about this dog?*

Adoption EventWebsitePet FindersFriend
Please indicate your reason for wanting to adopt this dog.*

CompanionWatch DogFamily PetGiftOther
Do you live in a*

HouseApartmentCondoMobile Home
Do you own or rent?*

OwnRent
If you rent, does your lease permit dogs?*

YesNoI don't know
Are there restrictions? (breed restrictions, age restrictions, etc.)*
May we contact your landlord?*

YesNo
Name of landlord
Landlord phone number

Area CodePhone Number
Do you have a fenced back yard?*

YesNo
If yes, is your yard fence secured?*

YesNo
Do you have a pool?*

YesNo
Is there a fence around the pool?*

YesNo
How long have you resided in your home?*
Please check all that apply*

Busy household (children, in and out a lot, visits by friends)Noisy (TV, stereo, machinery, tools, children playing, dogs barking)Moderate (normal coming and going)Quiet homebodies (come home, stay home)Lots of children in the neighborhoodLive on a busy street
How many people are living in the home, including yourself?*
Are their children living in the home?*

YesNo
Ages of everyone living in the home*
Do you or any family member have allergies to dogs?*

YesNoI don't know
Are all family members aware you are adopting a dog?*

YesNo
If yes, do they approve?

YesNoI don't know
Where will the dog be kept most of the time?*

CrateIndoorsOutdoorsGaragePatio/PorchOther
Where will your dog be sleeping?*

CratePet BedWith OwnerDesignated RoomOutdoorsGaragePatio/Porch
Where will your pet be when you are not at home?*

OutsideInsideCrateOther
What will your do for exercise and potty breaks?*
Who will be responsible for feeding and caring for the dog?*
How long will the dog be alone in a typical 24 hour day?*
How much money do you plan to spend on the dog in an average year for medical care?*
What arrangements will you make for your dog while you are travelling?*
Do you currently have any pets?*

YesNo
If so, Name, Breed, Age
Check all that apply

Up to date on vaccinesSpayed/NeuteredNot up to date on vaccinesNot spayed/neutered
Are your pets on any flea medication?

YesNo
Are they currenty licensed in your county?

YesNo
Have you had any other pets in the last five years?

YesNo
If so, what happened to them? (given away, passed away, ran away, accident?)
We don't always know if a dog is potty trained. Are you willing to potty train your pet?*

YesNo
Do you have any experience with the following?*

Crate TrainingObedience TrainingRaising a LitterModifying Behavioral IssuesPotty Training
Please list any other experiences that you feel will be beneficial in adopting one of our dogs.
Are you willing to commit to a training class/program if needed?*

YesNo
Please check types of confinement you can provide.*

CrateFenced YardKennel RunOther
How long are you willing to allow time for bonding?*

One WeekTwo WeeksOne MonthOther
If your present living conditions were to change (job, move, divorce, etc.) what arrangements will you make for your dog?
Under what circumstances would you feel it necessary to give up this dog?*

Dog barks or whinesDog has potty accident in the homeDog damages propertyDog becomes aggressiveDog becomes very illYou move to another stateOther
Have you surrendered a pet to the Humane Society or animal shelter?*

YesNo
If "Yes" please explain.
Have you ever been convicted of animal cruelty or neglect? If so, please explain.*
Any animal violations? If "Yes", please explain.*
If your pet went missing, what would you do?*
Have you ever been denied pet ownership from a rescue organization?*

YesNo
Please provide three references that we may contact. Include name, phone number and relationship.*
May we contact your veterinarian?*

YesNo
Name of veterinarian

First NameLast Name
Phone Number

Area CodePhone Number
Would you object to a home visit by one of our representatives?*

YesNo
If "Yes" please explain.
IMPORTANT! Please read the following: All of the information I have provided is true and complete to the best of my knowledge. I agree to follow the rules and policies of Leashes of Love Rescue, Inc. I understand it is my decision on whether to adopt a dog or not. I will not hold Leashes of Love Rescue, Inc. responsible for any damage, injury or harm caused directly or indirectly to any person or property by any dog I may decide to adopt. LEASHES OF LOVE RESCUE, INC. AT ITS SOLE DISCRETION, RESERVES THE RIGHT TO REFUSE ANY APPLICANT FOR ANY OR NO REASON.
I agree to the terms as stated above.*

AgreeDisagree
Please enter today's date.*

MonthDayYear
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