LDR Adoption Application

Please put N/A for any question that doesn't apply to you.
Completion of this application Does Not guarantee the adoption of a rescue animal.

Date Date / MM / DD YYYY
Name of the dog you are interested in adopting.
Family Information
Name Name First Last
Occupation
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Number of Children
Children's names and ages
Home Information
Landloard's Name Landloard's Name First Last
Landloard's Phone Landloard's Phone - ### - ### ####
Type of Home
Do you rent or own?
If you rent do you have written authorization to have a pet?
How much time will the dog spend without human company?
How much time will the dog spend outdoors?
When left alone where will the dog be located?
What parts of the house will the dog be allowed access too?
What parts of the house will the dog not be allowed access too?
Where will the dog sleep at night?
Is your yard fenced in?
How high is the fence in feet?
What is the fence constructed of? e.g. chain-link, cinder block, etc.
Do you have a doggy door?
Do you have a pool?
If you have a pool is it fenced in (pet safe)?
Pet information
Why do you want a dog?
If you want the dog for other reason(s) please specify:
Do you have other pets? If so please liet them.
Please tell us anything else you think we should know.
By signing this application I certify the information I have provided, to the best of my knowledge, is accurate and true. I understand the completing this form does not guarantee a dog for adoption.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Spam Protection. Please answer this simple question:
If the bird is blue, what color is it?

LDR Adoption Application

LDR Adoption Application

Family Information

Home Information

Pet information