Dog Adoption Application Form

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Dog Adoption Application
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Name of Pet You Wish to Adopt* This field is required.
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What characteristics do you desire in a pet?* This field is required.
Active
Mellow
Lap Dog
Good with Dogs
Good with Children
Good with Cats
No Shedding
Constant Companion
Independent
Large Breed
Medium Size Breed
Small Breed
Adult
Puppy
Senior
Special Needs
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Describe in detail the kind of pet you're looking for:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Your dog will be living:* This field is required.
Indoors
Outdoors
Indoors with access to outdoors (Dog Door)
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Primary Applicant* This field is required.
First Name
Last Name
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Applicant Birthday?* This field is required.Please provide your Birth Date mm/DD/yyyy
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Co - Applicant
First Name
Last Name
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Email Address* This field is required.
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Phone Number* This field is required.
Area Code
Phone Number
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Do you own or rent?* This field is required.
Own
Rent
Live with Parents
Live with Roommate
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Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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How long have you lived at this address?* This field is required.
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Your Occupation: * This field is required.Name of Employer? How long have you been employed?
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Do you own any pets?* This field is required.
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Pet Name(s) and breed* This field is required.
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Are current pets spay and neutered? * This field is required.Vetting up to date
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Are current pets on flea and heart worm prevention and up to date on vaccines?* This field is required.
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Pet's disposition and behavior towards other dogs/cats?* This field is required.
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Please provide your veterinarian's name and phone number:* This field is required.
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List any past pets and reason they are no longer with you.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Do you have a yard?* This field is required.
Yes
No
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If "Yes" to the above, is it fenced? please describe type and heightType of fence
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If no fenced yard, what provisions are there to protect and control your dog during exercise, play and potty breaks?* This field is required.
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What is your landlord's pet policy?* This field is required.Breed or size restrictions
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If you rent, please provide your landlord's information here:* This field is required.
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Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?* This field is required.
Yes
No
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Are there children in the home? (If yes, please list ages)* This field is required.
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How many hours per day would the pet be alone?* This field is required.
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Where will your pet be kept when your not home during day or night? When out of town?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Will you crate your pet?* This field is required.
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If you have to leave town, emergently or planned, where would your pet stay?* This field is required.
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How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?* This field is required.
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What are willing to pay for routine vetting visits?
$100
$200
$500
whatever it takes
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What are you willing to pay for emergency vetting visits?
$200
$500
$1000
whatever it takes
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What if the cost goes over that amount?
Huge
Large
Normal
Small
Ok
Ok
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Please provide the names and contact numbers for 3 personal references:* This field is required.
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Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?* This field is required.
Yes
No
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If you answered "Yes" please provide a detailed description:
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Signature of Potential Pet Parent* This field is required.
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By clicking the submit button, I agree to Loving Heart Animal Shelter adoption process, will undergo a homecheck, and interview at the discretion of Loving Heart Animal Shelter.

By clicking the submit button, I understand Loving Heart Animal Shelter will check my references including veterinary and personal.

By clicking the submit button, I understand there is an adoption fee associated with adoption of a pet from Loving Heart Animal Shelter.

By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Loving Heart Animal Shelter BY EMAIL or PHONE to make arrangements for my pet to be taken back into rescue.

By clicking the submit button, I agree to indemnify and hold harmless Loving Heart Animal Shelter against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.

By clicking the submit button, I understand that Loving Heart Animal Shelter will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.

By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Loving Heart Animal Shelter and provide transport to where Loving Heart Animal Shelter deems appropriate.

By clicking the submit button, I verify all of the above information is true and accurate.
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