First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

What is your date of birth?*

Do you intend to adopt this dog as a companion for yourself and/or immediate family and for the dog to reside with you at your primary location? Who is this pet intended for? *

If No, where, and with whom will the dog reside?

Have you, as an adult, ever adopted an animal from a shelter or rescue before? If so, please tell us about the animal and your experiences.

Please list the NAME and AGE of every individual in the household.*

Does everyone in this household agree to and support the adoption of this dog?

Please list all of the pets within your household? Species, breed, gender, age, how long you’ve had them in your household, behavior and personality? If none answer NA*

Are your dogs and cats currently up to date on their vaccinations? We will need to verify this with your veterinary reference. If you use a low-cost or mobile vaccination clinic, you will need to provide copies of your pets' vaccination record before your application can be approved. Please understand that applications will not be fully processed until records are confirmed.

Please list your VET CLINIC. Please list the clinic’s name and phone number We will be calling your veterinarian for a reference. If your pets' account is under another name, such as a maiden name, extended family, etc., please provide that information here so that we may more easily verify your reference. *

Are you the LEGAL owner of the property you live in, meaning that YOUR NAME appears on the deed of the property/property tax bills? (All property ownerships will be verified.)*

If you rent, you must provide the owner's name and phone number.

Do you have a completely fenced yard?

If yes, what is the height of the fence?*

Would your adopted dog ever be "tied up?" If yes, for how long?*

Where will your pet stay in the event of inclement weather or cold temperatures?*

What does a typical week in your life look like? How often are you home to provide care for your foster(s) If fostering Dogs (i.e. Where will the dog wake up, eat, how long will the dog be left by himself/herself, what does the dog's exercise plan look like, does your dog accompany you to work, etc.)*

Do you require an already house trained dog? If no, are you able to house train?*

Please describe your past experience handling animals? Have you ever had to deal with an animal that had issues such as aggression, fearfulness, shyness, or any other “problematic” behaviors? How did you help the animal overcome these challenges?*

Have you ever adopted ANY animal from LAWS before? If yes, who did you adopt? If not applicable, please write "N/A"*

Have you ever surrendered a pet to a shelter or rescue group, or re-homed it on your own (family member, advertising, etc)? If so, please describe the circumstances that led to the surrender.*

Please describe your current adoption search. How long have you been looking for a dog? What qualities are you looking for in a dog? What breeds do you have experience with?*

If there a specific dog you are interested in, please write his/her name here: (please note- while you may apply for a specific animal, we cannot guarantee that it will result in the adoption of that specific animal).

Please list the NAME (first and last) and PHONE NUMBER of at least 3 (three) references. Describe how you know each reference. Your application cannot be processed if we cannot speak with ALL of your references. NOTE: Please inform your references that you have given us their name and number and will be contacting them.*