Adoption Application
Email address *
Name *
First and last name
Email *
Phone number *
Occupation *
On average how many days a year do you travel for work? *
Address *
How long have you been at this address?
Daytime Phone
Evening Phone
Cell phone *
Best Time to Contact *
How many adults are there in your household & their relationship to you?
How many children are in the house, please specify gender, age & their relationship to you? *
What type of home do you live in single family, town home, apartment, farm, etc.? *
Which best describes your household : *
Do you rent or own your home? *
If you Said “Yes” to above, please answer the governing rules of your apartment: (check all that apply *
Required
Provide your landlord / Management Company’s name and contact: (by providing this information you are allowing L&L Foundation to contact your landlord please inform them of this call so they will speak with us)
Does anyone in your household have an allergy to dogs? *
Is everyone in your household in agreement with the decision to adopt a dog? *
How many hours will you be leaving the dog alone (be honest)? *
What other pets do you have (specify type and amount)? *
Are these pets up to date on vaccines? *
Are these pets spayed/neutered? *
If not spayed, or neutered, please explain *
Have you every surrendered a pet? If so, why? *
Have you ever had a pet euthanized? If so, why? *
Have you ever lost a pet to an accident? *
How do you discipline your pets and why? *
Do you have a regular veterinarian? *
Veterinarian's name and contact info: *
Do you agree to contact L&L if you can no longer keep this dog? *
Are you be willing to let a representative of L&L visit your home by appointment? *
Reference 1 (name, contact, relationship) *
Reference 2 (name, contact, relationship) *
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian and most of all you will provide unconditional love. *
Name and Date (by providing my electronic signature, I am validating that all the information provided is true to the extent of my knowledge)
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