Dog/Puppy Adoption Application

Name(s) of animal(s) you are applying to adopt*

Your name*

Driver’s License number*

Mailing Address*

City*

State*

Zip Code*

Physical Address*

City*

State*

Zip Code*

Home Phone*

Day Time Phone*

Email*

Names and relationships of individuals over 18 years old living in your home*

Number of children under 18 and their ages*

How long have you lived at your current address?*

In what type of residence do you live?*

If you live in an apartment or condominium, on what floor do you live?*

How many units are there?*

Do you currently own or rent your residence?*

What was your previous address?*

How long did you live there?*

If you currently rent, what is your landlord's name?*

Landlord's Phone Number*

Your Occupation*

Your Employer*

How long have you worked at your current job?*

What days do you currently work?*

What hours do you currently work?*

Spouse's/Parter's Occupation*

Spouse's/Partner's Employer*

How long has your Partner/Spouse worked at his or her current location of employment?*

What days does you Spouse/Partner currently work?*

What hours does your Spouse/Partner currently work?*

List the number and type of animals that you have cared for in the past 5 years.*

How many of these animals do you still care for?*

What happened to the animals you no longer care for?*

If animals were given away or returned, please explain.*

Please list all animals you CURRENTLY care for, including name, species, age, sex, whether or not they’re spayed/neutered and the date of their last rabies and distemper vaccinations:*

Veterinarian*

Veterinarian's Phone Number*

Do we have permission to verify your records with your veterinarian?*

Adopting a dog or cat brings with it a lot of responsibility, including annual veterinarian visits, vaccinations, and possible emergency care. This is more expensive than many people realize. Are you aware of and prepared to assume the financial responsibilities for this animal?*

How much do you expect to spend annually caring for a pet?*

Why do you want to adopt this animal?*

Who in your household will be primarily responsible for the care of the animal you wish to adopt?*

Will this be the first dog you've cared for as an adult?

Will this dog/puppy live inside your home?

If no, where will this dog/puppy live?*

Dog House
Kennel or Pen
Fenced Yard
Cable Run
Loose in the Yard
Barn
Basement

If yes, when the dog/puppy is outside, how do you plan to keep the dog/puppy confined to your property?*

Trained to Boundaries
Fenced Area
Tied
Kennel
Underground Fence
Cable Run
Walked on Leash

If you have a fenced area, what are the dimensions (length, width, height)?*

Is there shelter and shade available? If so, what kind?*

Please describe your property including roads, your land, nearby buildings, structures on your property (sheds or barns), fences, etc. We would like to know where your house is in conjunction with the roads as well as what the area looks like surrounding your home. This will aid us in ensuring you have selected the right animal for your lifestyle.*

Where will the dog/puppy be when you are away for the day or a few hours?*

Where will the dog/puppy be when you are on vacation?*

Do you plan to exercise this dog/puppy on a regular basis? If so, how?*

Do you intend to take this dog/puppy through obedience training?*

What kind of behavior traits in a dog/puppy do you find unacceptable?*

SIGNATURE

PLEASE READ AND INITIAL LMHS receives animals from a variety of sources including stray and abandoned animals. We also accept animals surrendered by owners. While we make every effort to screen animals for both health and behavioral issues, LMHS cannot guarantee the health or temperament of any animal. By initialing here, you acknowledge you have read and accept this statement. Initial Here: DISCLAIMER If Lucy Mackenzie Humane Society (LMHS) feels the animal you are applying for is not appropriate for you, your family and/or lifestyle, we will be more than willing to work with you in choosing the pet best suited for your needs as well as taking the animals needs into consideration. We work very hard to permanently place our animals in homes where both you and they will be happy. LMHS reserves the right to verify all information on this application. False information of any kind will result in an automatic refusal of your application. We also reserve the right to refuse any adoption application for any reason. This completed application is the property of LMHS and is not to be removed from the LMHS files without explicit approval of the Executive Director. Typing your name below verifies that the information you are submitting in this application is true and complete to your knowledge.

Please type your name below:*

Today's date*