APPLICATION FOR ADOPTION (2015-2016)
Little Black Dog Rescue
APPLICATION FEE
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EXAMPLE OF TRANSACTION ID
ENTER APPLICATION FEE RECEIPT / TRANSACTION NUMBER BELOW. DO NOT ENTER YOUR CREDIT CARD NUMBER, THIS FORM CANNOT PROCESS SECURE CREDIT CARD TRANSACTIONS. ** A $20 application fee is required to be considered. Please pay with Paypal using this link: https://goo.gl/VT1cdP and paste your receipt/ transaction ID below. (Please note: this fee is non-refundable and goes toward the adoption fee). *
When the transaction is complete, click "Return to Merchant" to return to this form. Please enter the receipt/transaction ID or number below. Only applications with a valid receipt/transaction ID will be accepted. The receipt/transaction ID can also be found in your receipt email from Paypal. DO NOT ENTER YOUR CREDIT CARD INFO HERE.
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APPLICATION
Name of Animal(s) you are applying for *
Your answer
What is the earliest date you will welcome a new dog into your home? *
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Personal Information
Applicant Name *
(First and Last)
Your answer
Applicant Email *
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Applicant DOB *
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Applicant Phone *
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Co-applicant Name
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Co-applicant DOB
Your answer
Co-applicant Phone
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Relationship
Street Address *
Your answer
Apartment / Suite
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City *
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State *
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Zip Code *
Your answer
Employer name, address & phone *
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Position
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Employer name, address & phone
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Employer name, address & phone
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Position
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Explain how you would resolve issues relating to new children and your dog:
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How many days a month are you out of town (business or pleasure) - Applicant *
Your answer
What is your work schedule (applicant and co-applicant)? *
Your answer
How many days a month are you out of town (business or pleasure) - Co-applicant
Your answer
Are you currently working with any other rescues to find a dog for adoption? *
Required
Household Information
Type of dwelling *
Do you own or rent? *
If rent, please provide a copy of your lease or a signed and dated letter indicating you can have a dog.
If you are a RENTER please provide landlord name and phone number: *
(Please put N/A if you are not a Renter)
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Is your yard fenced? *
If so, how high?
Your answer
What is your plan if you cannot get home at the usual time?
Your answer
Does anyone smoke inside the home? *
List all human residents of your household other than applicant and co-applicant:
Enter Name, Age of each household member
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What is the children’s experience with dogs? Be specific.
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How will you prepare your children for a dog? Be specific.
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Has applicant or co-applicant ever applied to another rescue? *
If so, what was the outcome of that application?
Your answer
Who will be responsible for the dog? *
Your answer
All dogs adopted from LBDR will be spayed or neutered. Do you have any reservations or questions about that? *
If so, explain
Your answer
Where will the dog be during the day? Be specific. *
Examples: in a crate, gated area, our bedroom, name of other room, back yard.
Your answer
Where will the dog sleep at night? Be specific. *
Examples: in a crate, gated area, our bedroom, name of other room.
Your answer
For how long will the dog/puppy be alone during the day? *
Examples: number of hours / never
Your answer
What brand of dog food do you feed your dogs? *
Your answer
Who will care for your dog while you are away? Are you aware of the cost of overnight care? *
Your answer
How much do you think it will cost to care for your dog each year (food, vet care, license, toys, supplies, *
Your answer
If you move, what will happen to your dog? *
Your answer
Do you have plans to move or are you renovating your home in the next 9 months? *
Have you considered the full ramifications of caring for a dog for its entire life- including illness and old age?
Your answer
Have you considered that having a senior dog may require changes in your life *
including more frequent bathroom times, softer bedding, medication, ramps
Your answer
Will you make necessary changes willingly? *
Your answer
Please list all pets of all species that you have owned in the last five years:
Pet #1 - Name, Breed, Sex, Age (now or at death), Spayed/Neutered (Y/N), Present Location
Your answer
Pet #2- Name, Breed, Sex, Age (now or at death), Spayed/Neutered (Y/N), Present Location
Your answer
Pet #3- Name, Breed, Sex, Age (now or at death), Spayed/Neutered (Y/N), Present Location
Your answer
Pet #4- Name, Breed, Sex, Age (now or at death), Spayed/Neutered (Y/N), Present Location
Your answer
Date of Last Vet Visit
Your answer
Reason for Vet Visit
Your answer
If you ever had a pet die at an early age please explain: *
Your answer
How will you exercise your dog? *
Your answer
What kind of dog do you want and why? Be as specific as possible *
Your answer
Applicant- have you ever housetrained a dog? *
If you are applying for a puppy, have you cared for a young puppy before? If yes-from what age? *
Example answer: "Yes, from age 15" / "No, Never cared for a puppy before"
Your answer
If you are applying for a puppy, do you agree to have the puppy spayed/neutered by LBDR at the appropriate age? If you choose to spay or neuter at another vet, do you agree to provide proof? You will be financially responsible for that cost. *
Co-applicant- have you ever housetrained a dog?
If you answered yes, was your experience as an adult or a child?
Do you have a problem with a volunteer visiting your home before you adopt?
Select all traits your are looking for in a dog: *
Required
Please list any other qualities you are seeking:
Your answer
1. Reference #1: Please provide the name and contact information for the first reference (NOT related to you) who does not reside with you: *
First reference: Name / Relationship / Phone & email
Your answer
2. Reference #2: Please provide the name and contact information for the second reference (NOT related to you) who does not reside with you: *
Second reference: Name / Relationship / Phone & email
Your answer
Please provide the names and contact information for your veterinarian: *
Your answer
Training
Training is not an option. It is an obligation. It is not something to be done once the dog starts causing problems, it is how to prevent problems from starting. Teach the dog how to be the dog you want him or her to be.
Do you agree with the above statement, and promise to train your potential foster, foster, or potential dog for adoption? Are you willing to bring in a trainer or attend a training class? *
By checking "Yes" you agree to bring in a trainer or attend a training class.
What other training methods do you agree to implement? *
Please describe in detail.
Your answer
Are you familiar with crate training? *
Please describe in detail.
Your answer
Signature
I acknowledge that all of the information on this form is true and correct. I understand that any
misrepresentation of fact may result in the removal of the dog from my home by Little Black Dog Rescue.
Applicant’s signature *
Please type your legal name, only
Your answer
Date *
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Where did you hear about us? *
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