| Full Name: |
|
| E-mail Address: |
|
| Phone Number: |
|
| Home Address: |
|
| City: |
|
| State: |
|
| Zip Code: |
|
| Date of Birth: |
|
| Occupation: |
|
| Work Phone: |
|
| Employer: |
|
| Marital Status: |
|
| Do you have any Children?: |
|
| If you have children, how many and what ages are they?: |
|
| Are there any other individuals living in the same household? Names and ages: |
|
| Does anyone have allergies or asthma that would be aggravated by a pet?: |
|
| Have you ever owned a pet before? What kind?: |
|
| What happened to your previous pet(s): |
|
| Are there any other pets? Type, Breed, Age, Gender: |
|
| Are any of your pets spayed/neutered?: |
|
| Are any of your pets current on their vaccinations?: |
|
| Name and phone number of your past or present veterinarian: |
|
By typing your name and phone number in the box to the right you are agreeing to have all of your pets veterinary records released to Lost But Loved (L.B.L.) Animal Rescue either by phone, fax, or e-mail so that we can process your adoption application.
|
|
Do you rent or own? If renting, name and number of your landlord:
|
|
| Where will the dog(s) stay during the day and at night?: |
|
| Have you discussed adopting a pet with your family? Is everyone in agreement about adopting?: |
|
| Are you out of town a lot or travel much? If so, what do you plan on doing with the animal while you are gone?: |
|
| Will the dog(s) be with someone durring the day?: |
|
| Do you have a fenced in back yard? If so, what kind(material) of fence is it? How high is it?: |
|
| Would you take your dog through a basic obedience course if needed?: If not why? |
|
| Have you ever been convicted of animal abuse or animal cruelty? Have you ever been in jail? If so, please explain: |
|
| Would you be OK with LBL Animal Rescue doing a background check to make sure that all of the information listed above is correct?: |
|
| Name of dog(s) you are interested in: |
|
| Signature: |
|
| Date: |
|
|
|
|
