Long Road Home Rescue, Inc.

Long Road Home Rescue, Inc.

Adoption Application
Thank you for your interest in our wonderful dogs!

Please note that it may take one to two business days for us to respond.

We truly appreciate your interest, and we promise to get back to you as quickly as possible.

For questions or information about the rescue (including adoption requirements), please email us at lrhrescue@gmail.com.
Name of the dog you are applying for: *
Name*

First NameLast Name
Co-Adopter's Name

First NameLast Name
Your Birthday*

MonthDayYear
E-mail*
example@example.com
Cellphone Number*
Format: (000) 000-0000.
House Number
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
When is the best time to reach you?
House Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you planning to move in the next year?*

YesNo
How long have you lived at your current address?*
Employer Name*
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Do you ....*

OwnRent
Do you live in ... *

HouseCondoMobile HomeTownhouseApartment
If you rent, does your lease state you are allowed to have dogs?*

YesNoI'm not sure

Please list the Names and Ages of all the People and Children Living With You. *

Rows	Name	Age
1.
2.
3.
4.
5.
6.
7.

Is This Your First Experience Owning a Dog? *

YesNoI have had a dog growing up as a family pet but never on my own
What is the reason you are looking to adopt?*

Family CompanionGuard DogProtection for the HomeCompanion for KidsCompanion for Current PetAs a Gift
Do you have any preference to breed, sex, age, size, hair length? *

YesNo
If yes, please explain
Does Anyone in Your Home Have Allergies to Dogs? *

YesNo
If yes, please explain how severe

Please list the Names and Ages of all the Animals Living With You (exclude small animals/fish)

Rows	Name	Age	Sex	Breed
1.
2.
3.
4.
5.
6.
7.

Are All the Animals (excluding rodents and birds) Spayed/Neutered?*

YesNo
Have You Ever Had to Get Rid of an Animal? *

YesNo
If yes, please explain why
Do the Animals in Your Home Currently Have Any Behavioral Problems? *

YesNo
If yes, what behaviors and what you have done to resolve the problem
What Training and Behavior Modification Techniques Will You Use With Your New Dog?*
How Do You Plan To Exercise the Dog? How Often?*
How Many Hours a Day Will the Dog Be Left Alone? *

1-33-66-99 or more
Will You Hire a Dog Walker if You are Out of the House for Longer Than 8 Hours? *

YesNo
Will You Crate the Dog? *

YesNo

Where Will the Dog Be Kept While ... *

Rows
you're in the house
you're out of the house
there's company over
you're sleeping

What Will You Do With the Dog When You Go Away on Vacation?*
Who Will Take Care of the Dog if You Are No Longer Able To?*
What type of fence do you have on your property?
Does the fence cover the entire area where the dog will be without any access points where the dog can get out?

YesNo
If no please explain why
Current Veterinarian:
Name*
Phone Number*
Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Is this your current vet or do you plan to use them?*

CurrentPlan to use once I have a dog
Where and how do you plan to groom the dog?*
Do you plan to use a heartworm preventative and flea/tick preventative? What brand?*
Are you financially prepared to give your new pet routine and ER medical care? *

YesNo
When Will You Be Ready To Bring a New Dog Into Your Home? *

Please provide three references that we will contact before adopting a dog*

Rows	Name	Phone #	Address
1.
2.
3.

Would you object to an in home visit from Long Road Home Rescue?*

YesNo
I am ready for a 12-15 year commitment to the amazing dog I am about to adopt*

YesNo
Adopters From Out of The Long Island Area:

We ask that you provide us photos of your house and backyard. We especially want to see the areas where the dog will be kept and loved. We may ask a rescue group in your area to do a home check for us.

Please email all photos to lrhrescue@gmail.com
By signing this form, I/we acknowledge that the information on this form is true and correct. I/we agree to all provisions indicated on this form. I/we understand that any misrepresentation of fact may result in Long Road Home Rescue refusing adoption privileges to me/us. If my/our request for adoption is approved and later Long Road Home Rescue discovers the above information is not true or correct, this application becomes null and void. Because of my breach of contract, Long Road Home Rescue reserves the right to remove the adopted pet from my home, and I will be held responsible for any associated legal costs incurred as part of said reclamation process. In order to ensure the best homes for our rescued pets, we reserve the right to deny any adoption application.
Please note a donation is required for adoption, and is non refundable.

Long Road Home Rescue, Inc reserves the right to deny adoptions in order to find the most appropriate home.

For questions or information about the rescue (including adoption requirements) please email us lrhrescue@gmail.com
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