EmailMe Form - Animal Life Savers, Inc. Dog Application

We provide this application online, so you can save time by completing it in advance. You must be over 21 to submit an Animal Life Savers dog application.

Date *

MM / DD / YYYY

Dog's name your thinking of adopting? *

CONTACT INFORMATION

Name *

First Last

Address *

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

Please complete all fields in the address section.

Daytime Phone *

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

Evening Phone *

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

Home Email Address

Work Email Address

HOUSEHOLD INFORMATION

Please indicate how many of the following live in your household:

Adults: *

(over 18)

Children *

(under 18)

What are their ages?

Are all members of the household in agreement about adopting a dog? *

Yes

No

Do you own or rent your home? *

Own

Rent

If you rent please give us your landlord's name and phone number so we may verify that you are allowed to have pets:

How long have you lived in your house/apt.?

Do you have a backyard? *

Yes

No

If so is it fenced in?

Yes

No

If you have a fenced in yard what height is the fence?

Please note that a fenced-in yard is NOT a requirement for adoption unless specifically stated in the dog's description.

Please describe your home. Apartment, single family detached, duplex, etc.

EXPERIENCE

Please note that experience with dogs is NOT a requirement for adoption unless specifically stated in the dog's description.

Have you ever lived with a dog before?

yes

no

If yes, please describe your experience(s) and a brief history of what happened to the dog(s).

If your last dog has passed away, please state dog's name and date deceased.

Has your dog ever produced puppies?

Yes

No

Have you ever given a dog up to a shelter or rescue organization? *

Yes

No

Do you currently have any animal companions at home?

Yes

No

If yes please indicated type of animal and how many:If you have other dogs, where do you keep them when they are alone?

All dog(s) you currently own have been spayed or neutered.

Yes

No

If you have other dogs, where do you keep them when they are alone?

CARE OF THE DOG

How do you plan to have your new dog relieve itself?

Examples: Take him on walks, In your backyard, wee wee pads.

Do all adults in the house work full time? *

Yes

No

How many hours each day will your new dog be alone? *

How many hours each day will you spend time with your dog? *

How will your new dog be kept when it is alone? *

Where will your new dog sleep? *

What type of exercise will you provide for your dog? *

What sort of training do you plan on providing the dog?

REFERENCES

Please provide your veterinarian's name and phone number (if you have one). We will call them as a reference. If you do not have a veterinarian, please provide the name and number of a non-family member that we may contact.

ALMOST DONE!

Finally, please be advised that we ask for a donation of between $175.oo to $325.00 per adoption to help defray medical and rescue effort costs. Is this acceptable? All our dogs and puppies are spayed, neutered and receive all their initial vaccines. Most of our dogs are microchipped.

Yes

No

Please realize that dogs need vet care throughout their lives, including yearly boosters, heartworm and flea/tick preventive meds, etc. Please consider this before adopting.