New Leash on Life Application
Thank you for considering a shelter dog! Dogs who have gone through the New Leash on Life program have had a considerable amount of care and time devoted to them. We want to ensure that they find owners who are committed to their continued success. Please fill out the following application. Approved adopters should be prepared for a home visit. Because of the low number of dogs going through the program at a time, we’ll be happy to keep your application on file and consider you for the next available dog. Best of luck!
New Leash Dog's Name:
(write the name of the program dog you're interested in)
Your answer
Your Email: *
Your answer
Your Name: *
(first and last)
Your answer
Your Address: *
Your answer
Phone Number: *
(home or cell, please list the number where you are most easily reached)
Your answer
Work Phone Number *
(please include extensions if applicable; if no work phone, write n/a)
Your answer
Current Veterinarian *
(if you have owned an animal in the past, but don't currently own one, please list the most recent vet you've seen)
Your answer
References: *
Please provide at least two additional references along with phone numbers and/or email addresses)
Your answer
Why have you decided to adopt a dog from the Randolph County New Leash on Life program? *
Your answer
Are you willing and able to commit to 10+ years of dog care, including veterinary care and follow-up training? *
Your answer
If you are approved as a New Leash on Life adopter, but are not selected for the current dog, would you like to be put on a waiting list for the next cycle? *
Do you have a fenced yard? *
If you have a fenced yard, please describe the fenced area and fence type. If you don't have a fenced yard, please describe your plans for keeping your pet contained and exercised: *
Your answer
Do you own any pets? *
Are all of your pets spayed or neutered? *
If you own pets, please list their names, ages and species: *
(if you don't own pets, write n/a)
Your answer
If you own pets and they are not spayed or neutered, please explain the circumstances: *
(if you don't own pets, write n/a)
Your answer
Are all of your current pets on monthly heartworm preventative and up to date on vaccinations? *
Please describe each of your current pet's personalities: *
(if you don't own pets, write n/a)
Your answer
If you own cats, are they comfortable around dogs? *
Have you ever owned a dog that is no longer living with you? *
If you answered yes to the previous question, please explain the circumstances:
Your answer
Have you ever surrendered a pet to an animal shelter or given a pet away? *
If you answered yes to the previous question, please explain the circumstances:
Your answer
Have you ever visited a dog trainer or engaged in any basic obedience training with a pet? *
Are you willing to follow up with the dog trainers associated with New Leash on LIfe? *
Please list the members of your household, along with their age and relationship to you: *
Your answer
When you have visitors, how do you plan to introduce them to your new pet? *
Your answer
How have you taught your children (or how would you teach visiting children) to interact with a dog? *
Your answer
Who will be the primary caregiver for this dog? Who will care for the dog when the primary caregiver is away – at work or on vacation? *
Your answer
How many hours will the dog be left at home alone during the day? Where will the dog be kept during those hours? *
Your answer
Do you own your home or rent? *
If you rent, is your landlord agreeable to allowing pets? *
Please provide the name and phone number of your landlord:
Your answer
Where will your new dog sleep? *
Your answer
How do you plan to provide exercise for your dog? *
Your answer
The information provided in this application is true to the best of my knowledge as of the date of the application. *
(please write your name and today's date)
Your answer
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