2019 Dog Intake Application
PLEASE NOTE:
1) We are located in Tempe, Arizona and cannot assist with out of state rescue OR transport.
2) There is a $35.00 intake fee that is due at the time of intake.
3) You must complete ONE APPLICATION PER PET that is being surrendered.
4) You will be contacted by email within 24-48 hours of submitting this application with the status of your application. We do not process same day intakes or handle emergency situations.

Please answer the following questions as thoroughly as possible. Once you have completed this application, please send a photo of your pet to pic@lostourhome.org to complete your application. Please include your name, your dog's name, and specify that it is for the rescue/intake program. Your application will not be considered complete and will not be responded to until a photo is received.

Example: John Doe - Fido - Rescue/Intake Program

We will contact you as soon as possible upon receipt of the application.

Your First and Last Name: *
Your answer
Address (Street, City, State and ZIP Code) *
Your answer
Email Address (We communicate PRIMARILY VIA EMAIL) *
Your answer
Best Phone Number to Reach You: *
Your answer
Dog's Name: *
Your answer
Dog's Age: *
Your answer
Dog's Sex: *
Breed of dog: *
Your answer
How long have you had this dog? *
Your answer
Why are you surrendering this dog? *
Your answer
Does the dog have any history of biting or aggression? If yes, please describe: *
Your answer
How does the dog behave around other dogs? *
Your answer
How does the dog behave around cats? *
Your answer
How does the dog behave around kids? *
Your answer
Has the dog ever lived with other dogs, cats, or kids? Please provide details: *
Your answer
What is the dog's activity level? *
Where does the dog spend most of its time? *
Is the dog housebroken? *
Is the dog familiar with a dog door? *
Does the dog know any commands? If so, which ones? *
Your answer
Does the dog escape the home or yard? If so, please specify how high of a fence they can jump: *
Your answer
Does the dog have any destructive behaviors? Examples include chewing, biting, scratching, inappropriate urination/defecation, etc. *
Your answer
How does the dog act when left alone (does the dog bark, cry, sleep, chew)? *
Your answer
Is the dog spayed or neutered? *
Required
What vaccinations has the dog received? You must be able to provide proof of vaccination upon dog intake. *
Required
Does the dog have any medical issues, allergies, special dietary needs, etc? If yes, please provide information. *
Your answer
Was the dog previously adopted from another shelter or rescue? If so, which one? *
Your answer
Did you find this dog? If yes, how long ago and what were the circumstances? (e.g., where found, how long have you had it, etc.) *
Your answer
By what date do you need to re-home this dog? PLEASE NOTE THAT WE CANNOT PROVIDE SAME DAY APPOINTMENTS. *
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Additional Comments (please include any additional information that would be useful to potential adopters):
Your answer
Are you a Military Veteran? *
Does your annual income fall under the Annual Income Poverty Guideline? NOTE: This information is for internal use only and will not be used to determine the intake of your animal(s). *
Captionless Image
How many people reside in your home? *
Your answer
How many people in your household are age 17 or younger? *
Your answer
Unless otherwise approved and/or discussed with LOH Program Manager, I understand that I MUST submit at least one full body photo of this dog to pic@lostourhome.org. If no photos are received, this application is not considered complete and Lost Our Home Pet Rescue will NOT contact me. *
I understand that after this application and a picture have been submitted to Lost Our Home Pet Rescue, I will be contacted as soon as possible VIA THE EMAIL ADDRESS I HAVE PROVIDED (not by phone). Lost Our Home Pet Rescue will notify me by email if they are able to take in my dog and will provide me with other resources if they cannot take in my dog. *
I certify that I am the owner/finder of the animal described above and if my animal is accepted for intake, I will transfer ownership of said animal to Lost Our Home Pet Rescue, and relinquish all rights and privileges thereof. I understand that the animal will not be returned to me. *
By surrendering this pet, I understand that the Lost Our Home Pet Rescue becomes the legal owner of the animal and they may, at their discretion, elect to use the animal I am surrendering for media and/or publicity purposes. I also agree that I will not come back and visit my pet because it causes the pet undo stress. *
I understand there is a $35 fee for each dog I surrender to Lost Our Home Pet Rescue *
STAFF ONLY: Reason for Surrender
STAFF ONLY: POLICE DROP-OFF?
STAFF ONLY: IF YES, WHAT CITY?
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