Dog Adoption Application Form

Thank you for your interest in adopting a homeless pet! Filling out this application is the FIRST step in our adoption process. It does not mean that you are committing to adopting a dog, nor does it guarantee an adoption.

Applicants must meet the requirement of being at least 21 years of age. If you do not meet this requirement, we kindly ask that you wait to submit an application.

Please answer the questions of this application FULLY and COMPLETELY. This will help us find the best homes for the dogs in our care!

If your application is approved, shelter staff will be in touch with you soon. Since we are short-staffed at the moment, it may take shelter staff up to 1-2 weeks to send you a response.

Thank you for your patience and, again, for considering adopting a dog from our shelter!

Why do you want to adopt a dog?*

What type of dog are you looking to adopt? Check all that apply:*

Are there other specific personality traits that you are looking for in a future dog or any activities that you want to do with a future dog (hiking, agility, etc.)? If so, list them here:*

Is there a specific dog that you want to adopt? List his or her name below. (Feel free to list multiple dogs if you are considering more than one.)*

What interested you in this specific dog(s)?

How did you hear about this specific dog(s)?*

Primary Applicant:*

First NameLast Name

Primary Applicant's Date of Birth:*

Date

Are your applying for yourself or for someone else?*

MyselfSomeone else

If you are applying for someone else, who are you applying for and why are you applying for them?

Primary Applicant's Email Address:*

Primary Applicant's Phone Number:*

Area CodePhone Number

Primary Applicant's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you lived at this address?*

Do you own or rent?*

OwnRentLive with parentsLive with roommate

If you rent, please provide your landlord's NAME, PHONE NUMBER, and PET POLICY here:*

Primary Applicant's Occupation: *

Co - Applicant:

First NameLast Name

Is everyone in your household in favor of adopting a dog?*

YesNoNot sure

How would you describe the activity level of your home?*

Lots of activity & noiseSomewhat noisyMostly calm & quiet

Are there children in your home? If yes, please list their ages:*

Do other pets or children visit your home often?*

Yes - childrenYes - other petsNo

Do you currently own any pets?*

YesNo

If you currently own pets, please include their NAMES, AGES, and BREEDS here:*

Do your current pets get along with other dogs? Please describe how they behave around other dogs:*

Are your current pets spayed or neutered?*

YesNoI do not have any pets.

Are your current pets up to date on vaccines?*

YesNoI do not have any pets.

Are your current pets on heartworm and flea preventative?*

YesNoI do not have any pets.

If you previously owned pets, please list them here and the reasons they are no longer with you:*

Have you ever surrendered a pet you owned to any animal shelter, including a "low" or "no-kill" shelter?*

YesNo

Do you have a yard?*

YesNo

If you have a yard, is your yard fenced? If it is fenced, please include the height of the fence and the type of fence here:*

If your yard is NOT fenced or you do not have a yard, how would you protect and control a dog during exercise, playtime, and potty breaks?*

What veterinarian do you use? Please include the NAME and PHONE NUMBER. If you do not currently have a veterinarian, please include the name and phone number of the veterinarian you plan to use.*

Who will be this dog's primary caregiver?*

Most dogs live to be 10-15 years of age. Are you and your family prepared for the financial commitment, time investment, and energy that owning a pet requires?*

YesNoI think so

Where will this dog be living?*

IndoorsOutdoorsIndoors with constant access to outdoors (dog door)Garage

Do you plan to use a crate?*

YesNo

If you plan to use a crate, where would you crate this dog and for how long?*

When you are NOT home, where would this dog be kept (crate, free range of house, etc.)?*

Approximately how many hours would this dog be left alone each day?*

If you have to leave town (planned trip or emergency), where would this dog stay?*

How would you deal with any problem behavioral issues, such as barking, chewing, destructive behaviors, accidents indoors, or unruly leash behavior?*

What situations, problem behaviors or not, would cause you to give up this dog?*

What are you willing to pay for routine vet visits?*

$100$200$500Whatever it takes

What are you willing to pay for emergency vet visits?*

$200$500$1,000Whatever it takes

What would you do if routine or emergency vet bills went over your expected amount?*

Please provide the names and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes," please provide a detailed description of what happened:*

By clicking the submit button, I agree to Loving Heart Animal Shelter's adoption process, will undergo a home-check, and may be interviewed at the discretion of Loving Heart Animal Shelter.
By clicking the submit button, I understand Loving Heart Animal Shelter will check my references, including veterinary and personal references.
By clicking the submit button, I understand there is an adoption fee associated with the adoption of a pet from Loving Heart Animal Shelter.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Loving Heart Animal Shelter BY EMAIL or PHONE to make arrangements for my pet to be taken back into the care of Loving Heart Animal Shelter.
By clicking the submit button, I agree to indemnify and hold harmless Loving Heart Animal Shelter against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Loving Heart Animal Shelter will disclose any of the pet's health or behavior issues known by the above named rescue group before the adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Loving Heart Animal Shelter and provide transport to where Loving Heart Animal Shelter deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of potential pet parent:*

Loving Heart Animal Shelter

Dog Information

Applicant Information

Household Information

Dog Care Information

References/Closing