OLBH Adoption Application

OUR LIL' BIT OF HEAVEN ANIMAL RESCUE AND SANCTUARY

4259 Mangus Road, Spencer, IN 47868 ownedbycaninesandloveit@yahoo.com
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Full Name
First Middle Last
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have you ever been convicted of a felony or have been adjudicated?
A background check will be made and preclude you from adoption based on the findings.
Email
example@example.com
Phone Number

Area CodePhone Number
Name of Dog(s) interested in and why:
Do you qualify for either program and wish to adopt an older dog? (please review the details on our website)
Sometimes animals in rescue come from abusive/neglected situations and my have difficulty making the transition to a new home. Are you willing to be patient while the canine adjusts to a new home?
Are you open to working with someone from this rescue to assist in transitioning the canine should any behavior problems arise?
Do you understand this canine will require proper grooming, annual vet visits, dental care, daily exercise, proper grooming, and mental stimulation? Are you willing to provide this care for the lifetime of this canine?
Will the canine live inside your home?

Other
OLBH requires a secure fence (invisible fencing is not approved). Describe the fencing around your home that the canine would be contained in:
Type/Height/Locked Gates?/Size/Etc.
How many hours a day would the canine be without someone there?
How/Where will the canine be kept during your absence?
Do you currently own any pets or animals at this time ?
If you have had pets in the past, please describe type/breed and why you no longer have them:

Current Pet Information

Rows	Dog/Cat Breed if Dog	Spayed or Neutered?	Age	Up-to-Date Vaccinations?	On current Heartworm and Flea/Tick Preventative?
Pet #1
Pet #2
Pet #3
Pet #4
Pet #5
Pet #6

This canine is currently on premium food, what food do you plan on providing?
Please provide your current or most recent Veterinarians Name, Address, Phone. (if more than one, please list all). If you currently do not have pets, what Veterinarian will you be using for this canine should the adoption be approved?
What is your current living situation?
If you rent, does your lease allow for pets?
If you rent, please provide Landlord's Name and Contact Information (if own, put N/A):
How long have you been at this residence?
Please list Names and Ages of those in your household:
Name, Age
Current Employer and length of employment (for each adult in household):
Household Annual Salary:
Please provide Names, Contact Numbers, and best time of day to reach 2 personal references (may not be family members) Please let your references know to expect a call from us. If after one voicemail left we have not received response from your reference(s), your application will be filed and not finished.
Name/Phone/Best time to reach
It is understood that we (OLBH) require a home visit prior to fully approving an adoption or any placement of one of our canines. This visit will be scheduled with you upon approval of this application.

By submitting this Adoption Application, you are attesting to the accuracy and truth of all answers given on this form. If any of the information you have provided proves to be false, this will automatically void this application.

By submitting this Adoption Application, you are confirming you have read and understand this application in its entirety.
I have read, understand, and agree to the above statements:
Should be Empty:

OUR LIL' BIT OF HEAVEN ANIMAL RESCUE AND SANCTUARY