Mr. Bean’s Calendar

Pet Name or Breed *

Your Name *

Street Address - Please enter your physical street address, city, state and zip code. *

Please enter your physical street address, city, state and zip code.

Email *

Best Telephone Number 000-000-0000 *

Current Veterinarian and Telephone Number *

We will contact your vet to verify that all pets are up to date on vaccinations.

I wish to adopt a dog because... *

Please elaborate, we really want to know!

Non-family personal reference and phone number. Someone who knows you well and can speak about your personality, living situation, work ethic and how you care for animals. *

Non-family personal reference and phone number. Someone who knows you well and can speak about your personality, living situation, work ethic and how you care for animals.

Please check one. Are you?

Employer and Occupation *

Employer Telephone 000-000-0000 *

000-000-0000

Do you Own or Rent

Own
Rent

If you are renting, please enter your Landlords name and telephone.

We will contact your Landlord to verify the pet policy.

Type of housing

Names and ages of all individuals in the household (residing full or part time) *

My experience with Dogs.

First Time
Had One or Two
Experienced

Which, if any, of the following dog training or behavior issues have you had experience with, please check.

Please elaborate on None or Other

Do you have pets now?

No
Yes- Cats
Yes- Dogs

How many other cats? *

How many other dogs? *

Name of Cat or Dog, Age and Breed

Where did you get your pet(s)? *

How long have you had your pet(s) *

Are your current pet(s) Spayed or Neutered

Yes - All are Spayed or Neutered
Yes - Some are Spayed or Neutered
No - None are Spayed or Neutered

If you do not have a pet now; Have you had a pet in the past?

No - First time pet adoption
Yes - Dogs
Yes - Cats

Breed of pet(s) we have had before.

Was the pet Spayed or Neutered

Yes
No

Length of time you had the pet?

What happened to the pet?

How you ever adopted a pet from LSAR

Yes
No

Name of dog when adopted and approximate date

The next few questions refer to the dog you wish to adopt.

Please complete all entries.

Size of Dog.

Small: - 20 lbs.
Medium: 20-50 lbs.
Large: 50-100 lbs.
Giant: +100 lbs.

Gender

Either
Female
Male

Personality and temperament of dog should be:

Training Preference

None
Some Obedience
House Trained
Fully Trained

For Exercise I prefer a dog that:

I prefer a dog with an energy level that is

High
Moderate
Low

I presently have a

Height and type of fencing.

Where my dog will be during the day *

Where my dog will be during the night *

What length of time will you allow for your new pet to adjust to his or her new home? *

What is your care plan for your dog when you go on vacation or in the event of an emergency? *

What circumstances would lead you to give up or rehome your dog? *

How did you find out about adoption through LSAR? Check all that apply