First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Why are you interested in adopting a pet at this time?*

How long have you been thinking about adopting a new pet?*

Please list the number of people living in your home and include their ages:*

Do you have children that visit often? Or children that the dog will be around? (Ie kids of friends/family, or playmates of your children.) If yes, please list their ages. *

Is there a limit on the number of animals that you can have in your home with the county or city you live in and if so, what is that limit? *

Which animal are you interested in adopting?
Choose an animal: Bailey Barnum Marlow

Are all family members in your household in favor of adopting a new animal?*

Will all members of the household tolerate accidents while the pet is adjusting to the new household?*

Do you currently have any pets? Please describe all pets by breed, age, weight, sex and how long you've owned them:*

If you do not currently have a dog, have you owned one in the past?*

If you have owned dogs previously, but do not any longer, where are those animals now? *

Are your current pets spayed/ neutered?*

If one or all of your pets are not spayed or neutered, please tell us which are not, and why. For example; planning to breed, too young, etc. *

Are your current pets up to date on their vaccinations and given heartworm/flea/tick preventative each month?*

Please notify your current veterinarian (or last veterinarian) that A New Leash on Life Rescue will be contacting them and give permission for them to verify any of your past or current pets medical records. Please provide vets name and phone number:*

What traits are you looking for in a pet?

If approved to adopt, will the new animal be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day?*

How many days a week will the animal be alone for this amount of time?*

Where will the animal sleep?*

Where will the animal be kept when you ARE home?*

Where will the animal be kept when you are not home?*

Describe how you will train the pet:*

Do you have a fenced in yard? If yes, please list the type and height of the fence. (i.e. 4 foot chain-link fence.)*

If your yard is not fenced in, how will you take the dog outside?*

Do you agree to notify A New Leash on Life Rescue if your dog ever became lost or if you could no longer keep the pet?*

Have you ever given up a pet? If yes, please explain:*

List any reasons you would give your dog away (or return to us) (fleas, getting married/divorced, allergies, chews or destroys things, too expensive, children no longer take care of, shedding, moving, biting, other, etc.)*

Please list your occupation:*

Do you own or rent your current home? If you rent, do you have permission to have pets?*

If you rent your home, please provide us with your landlord's name and contact information so that we can verify animals are permitted on the property.*

Please understand, there are many times when a home visit is required before the adoption of this pet. Do you agree to a home visit? If not, please explain:*

Do you understand that we do NOT ship or transport any of our rescue pets and they MUST be picked up at our foster homes?*

If approved to adopt this pet, when would you plan on picking the dog up?*

Have you applied with any other rescue?*
Choose one: Yes No

Do you want to adopt the dog as a gift for someone else or for yourself?*

Adopting a pet is a great responsibility. You will be sharing your love with an animal that is totally dependent on you for food, shelter, clean-up and veterinary care. This involves financial commitment. Are you willing to make this commitment to your new pet?*

Do all the members of your household understand that it takes time for a pet to adjust to a new household?*

Any additional information you would like us to consider in reviewing your application. If you want us to hold this pet for any additional amount of time, etc. please indicate so here.*

Please list the ages of all adults in the home:*

I certify that the information entered on this application is true. Enter your name and date:*