| Pet Name: |
|
| Applicant Name: |
|
| Street Address: |
|
| City |
|
| State |
|
| Zip Code |
|
| Home/Cell Phone |
|
| Email Address |
|
| Current Veterinarian |
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| I wish to Adopt a
Dog Because: |
|
|
| Personal References (Please
List Two--Names, Addresses, Phone): |
| 1- |
| 2- |
About You and Your
Household--Please Check Appropriate Box (x):
**Are You:Working,
Homemaker,
Retired,
Attending
School, Other: |
| **Employer/Occupation: |
|
| Bus. Phone: |
|
**Type of Housing:
Home,
Condo,
Apartment,
Mobile
Home, RV
Own,Rent,Live
With Parents,Rent
Lot Space,Other:
|
| **Landlord's Name: |
|
| Phone: |
|
| **Others in Household: |
|
|
|
| |
|
**My Experience with
Dogs: First
Time,
Had
One or Two,
Very
Experienced
**Do You Have Other Pets Now?
Yes,
No,
If Yes: Cat,
Dog |
| Where Did You Get Pet? |
|
| Length of Time You Have Had Pet |
Years
Months |
| Spayed/Neutered?
Yes
No |
**If You Don't Have a
Pet Now, Have You Ever Had a Pet Before?Yes,
No
If Yes:Cat,
Dog |
| Breed: |
| Spayed/Neutered?
Yes,
No
|
| Length of Time You Had Pet |
Years
Months |
| What Happened To Pet |
|
| **Have You Ever Adopted
a Pet from LSAR
Yes,No
|
Your Preferences:
**Size of Dog I'd Like:
Small
(up to 20 lbs)
Med.
(20-50 lbs)
Large
(50-100 lbs)
Giant
(over 100 lbs). Prefer:
Male,
Female,
Either
**I'd Like these Personality/Temperament Traits in My Dog:
Quiet,
Mellow,Affectionate
Lap
Dog,
Protective,
Vocal,
Herder,
Retriever,
Loves
Water, Other:
**Training Preferences:
None,
Some
Obedience,
Housebroken,
Fully
Trained
**For Exercise I Prefer a Dog that:
Walks
on a Leash,
Walks
on & off Leash,
Will
Run or Hike with me
Will
Exercise Itself,
Requires
No Exercise
**I Prefer a Dog with an Energy Level that is:
High,
Moderate,
Low
**I Presently have:A
Fenced Yard,
An
Enclosed Kennel,
A
Stationary Tie-up, |
|
Other: |
|
| **My Dog would be (where) |
|
| during the Day, and (where) |
at night? |
