Dog Adoption Application – Last Chance Dog Rescue

Name

First

Last

Street Address

City, State, Zip

Drivers Licence Number

Phone Number & Email

Is Your Home a

Your Home Is

If Renting – is your name on the lease?

Yes
No

If Renting – Do you have your landlord's permission to have a dog?

Yes
No

Landlord's Name & Phone Number?

Who Shares Your Home?

Spouse/Life Partner
Boyfriend/Girlfriend
Roommate(s)

Are there children in the home?

Yes
No

If so, How Many and how old?

If your present relationship / living situation were to change and you were no longer able to care for the dog, we must approve the new owners or you can return the dog to us…… do you agree

Yes
No

Do you have a yard/space for your new dog to exercise

Yes
No

If not, will you exercise Him/Her daily

Yes
No

Your Experience with Dogs….How would you describe your dog owning experience?

Do you currently have any other pets… If yes tell us about them. Type, Breed, Sex, Ages etc. And how you feel your new dog will fit in with them.

If you have children in your household, please their experience with dogs.

Please tell us why you want to adopt a rescue dog?

Share your reasons for wanting a dog… Family Pet, Companion for you or another pet, guard dog etc.

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new dog?

Yes
No

Are you able and willing to make a long-term commitment to care for your pet for its entire life span, which could be as long as 15 years or more?

Yes
No

Is there anything else you would like to share with us or any concerns?