EmailMe Form - LOUS Place Rescue Adoption Application

Date

MM / DD / YYYY

Name of Dog Applying for
OR Breed/Type

Where did you hear about LOUS (if Newspaper, which one)?

Applicant(s) Name *

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

EMAIL where you can be reached *

CELL PHONE *

### - ### - ####

Occupation and Length of Employment of all Adults living in the home

Why do you want to adopt this dog/puppy?

What do you think are the most important responsibilties in owning a dog?

Please list any preferences (age,sex, breed, personality)

Have you submitted an application with another organization for a dog at this time? If Yes, please list

Are you willing to take the time to house train a dog, and do you understand that changing a dog's environment may cause the dog to have accidents?

If a behavioral problem arises, what steps will you take to work on it?

If you are applying for a puppy/dog who is not house trained, how will you house train the dog?

Do any members of the family have allergies to animals?
If yes, explain

Describe the kinds of personal situation where you might have to return your adopted dog. IE job loss, children, move, marital change, etc.

For whom are you adopting the dog?

self

gift

other family member

How many people live in your home?

Please list the names/ages of the people living with you. If none reside enter '0'

Who will be responsible for feeding and taking the dog outside?

Who will take care of the dog in the absence of the primary caretaker?

What reading and/or other steps have you taken to prepare for a new dog?

Will you enroll in obedience training?

Will you be willing to obtain an appropriately sized crate if recommended?

Describe any pets you currently own. Name, Breed, Age, Sex

Are ALL pets Spayed or Neutered? If not, please explain.

Are ALL pets primarily Indoor or Outdoor?

List each vet/animal hospital where your animal(s) received care over the last 5 years. Name of the Business and a Phone Number with Area Code

Have you considered the extra expenses that will come with having a dog including vet care, food, supplies and equipment, toys, training and boarding?

What type of residence do you reside in?

Do you own or rent? If rent, Please include your landlord's Name and Contact info.
Please NOTE: We will verify this information

Do you have a fenced yard?

YES

NO

What type of fence? What is the height? If no fence, how will you contain your dog while outdoors?

How often will you exercise the dog and for approximately how long?

When no one is home (i.e. at work, shopping), where will the dog stay? What is the average time home alone on a daily basis?

Where will the dog sleep?

If you move, what will you do with the dog?

What dog food do you plan on feeding? If unknown, LOU'S Place can recommend one.

Are you aware LOU'S requires all dogs/cats in a home be spayed/neutered? *

YES

NO

Are you aware the adoption donation requested is non-refundable? *

YES

NO

Do you agree to a Home Visit to finalize the adoption? *

YES

NO

Have all adult family members agreed to adopting this dog/puppy? *

YES

NO

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that LOU'S Place Rescue (LOU'S Place) reserves the right to annul the adoption and reclaim the animal. I give LOU'S Place permission to fully investigate the information provided as well as contact veterinarians and related officials.

In addition, I understand and agree the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is LOU'S Place prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated by LOU'S Place, I am free to apply and undergo the application process in the future.

Please Enter Your Name if you agree to the terms outlined.