Dog Adoption Application

Name of Dog If known, name of dog you are interested in:

Your Name Your Name

Your Email Address Your Email Address

Your Phone Number Your Phone Number

Your Age Your Age

Your Street Address Your Street Address

City, State & Zip Code City, State & Zip Code

Your Occupation Your Occupation

Partner/Spouse's Occupation Partner/Spouse's Occupation

Describe Your Living Situation Describe Your Living Situation Describe Your Living Situation Own Rent Live with Parents Share an Apartment

Do all adults in household agree to adoption? Do all adults in household agree to adoption? Yes No

Contact Information If you rent, live with parents or share an apartment please provide names and phone number (landlord, Parents, roommate’s info) you give us permission to contact:

Household Members List all Family Members in the house including children. (Please include their age and your relationship to them)

Would you object to Last Hope doing a home inspection? Would you object to Last Hope doing a home inspection? Yes No

What kind of dog are you looking for? (Check all that apply) What kind of dog are you looking for? (Check all that apply) Puppy Young Adult (1-2 Years) Adult (2+ Years) Senior Male Female Small (Under 25lbs) Medium (25-50lbs) Large (50lbs+) Active/High Energy Medium Energy Couch Potato

Dog Breed What dog breed are you looking for?

How would you describe your past experience with dogs? (Check all that apply) How would you describe your past experience with dogs? (Check all that apply) Never had a dog Had a dog as a child Have experience with strong or high energy dogs Have experience with shy dogs Had one or more dogs as an adult Have experience with a dog with medical issues Have experience with a dog with behavioral issues Have worked at veterinary hospital I am a professional dog trainer

Household Pets List Current/Past Pets Owned in the Past 10 Years. (Please Include Species, Breed, Name, Age, Sex, Spay/Neutered Status, & If The Pet Is Still Living)

Have you ever given up a pet/surrendered it to a shelter? Have you ever given up a pet/surrendered it to a shelter? Yes No

Explaination If Yes, Please Explain:

Do you intend on being a multiple pet home? Do you intend on being a multiple pet home? Yes No

Number of Pets If yes, how many do you plan to have?

Describe Your Yard Describe Your Yard Describe Your Living Situation No Yard Fenced in on 4 Sides Fenced in on Less than 4 Sides

Height If you have a fence, what is the height of your fence?

Material If you have a fence, what is the material of your fence? (i.e. wood, PVC, electric, chainlink, etc.)

Will the dog be a house pet? Will the dog be a house pet? Yes No

Hours Left Alone How many hours during the day on average will the dog spend alone?

Are you willing to hire a dog sitter? Are you willing to hire a dog sitter? Yes No

Do you plan on crate training the dog? Do you plan on crate training the dog? Yes No

Location Where will the dog be when someone is home?

Location Where will the dog be when alone?

Location Where will the dog sleep at night?

Is anyone in your family allergic to animals? Is anyone in your family allergic to animals? Yes No

Are there any deal breakers for your new pet? (i.e. Gets along with cats/dogs, good with kids, good watch dog or doesn’t bark) Are there any deal breakers for your new pet? (i.e. Gets along with cats/dogs, good with kids, good watch dog or doesn’t bark) Yes No

Explaination If yes, please describe your deal breakers.

Are you prepared to deal with any special health issues if the animal needs special care later in life? Are you prepared to deal with any special health issues if the animal needs special care later in life? Yes No

Are you aware that preventive shots and routine vet care can typically cost $200-$2000 per year? Are you aware that preventive shots and routine vet care can typically cost $200-$2000 per year? Yes No

References Please provide three personal, non-family member, references we can contact along with their contact information.

Vet Reference Vet Reference: (Please contact your vet and let them know the rescue will be calling for a reference). Include the vet name, contact information, and the name your account is under.