Large Breeds and Special Needs Rescue
Adoption Application
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Full legal name and date of birth for all adults in household.
Phone Number
-
Area Code
Phone Number
Employer
Occupation
Number of hours worked per day?
Where will your new family member stay while you are at work?
Where will your new family member sleep?
How many hours a day will your new family member be crated?
Where will your new family member stay while you are on vacation?
Do you have other pets in the home?
Yes
No
Are other pets spayed or neutered?
Yes
No
N/A
Are all pets on heartworm and flea and tick prevention?
Yes
No
N/A
Do you have any outside pets?
Yes
No
Tell me about any other pets you have.
Name, number and address of veterinarian able to speak on your behalf.
Why do you want to adopt?
Companion
Companion for pet
Child or children's pet
Gift for someone
Guard dog
Other
Have you ever surrendered an animal to animal control, a humane society, an animal shelter or rescue? If so, please explain the circumstances.
What type of home do you live in?
Single Family
Condo
Apartment
Other
Does your home have stairs?
Inside
Outside
Both
None
Do you own or rent your home?
Own
Rent
If rental, name and address of landlord is required.
Do you have a fence?
Yes
No
If you have a fence, what type?
Do you have a locking gate?
Yes
No
Do you have a pool, hot tub, koi pond, other pond or lake access from your home and is that area secured? Please explain.
Do you have county ordinances or restrictions regarding pets?
Yes
No
Do you have any HOA restrictions regarding pets?
Yes
No
Do you have any insurance restrictions regarding pets?
Yes
No
Do you have a calm, safe space to separate your new family member if needed?
Yes
No
Accidents, chewing, jumping, nipping, mouthing, leash pulling, etc, are all inappropriate behaviors, but are likely to happen as your new family member adjusts to a new environment. Are you willing to invest in training?
Yes
No
Under what circumstances might you return a pet?
Do you anticipate any life changes that may render you unable to provide proper care for a pet? Please explain.
All Large Breeds and Special Needs rescues are fed a grain free or raw diet and must remain on HW prevention. Not only are annual visits essential, they must receive prompt veterinarian attention to any ailment. Are you in a financial state to take on that responsibility?
Yes
No
Are there children in your home?
Yes, over age 5
Yes, under age 5
None
Visitors with children
Other
Children ALWAYS need to be supervised around any animal. Do you understand and accept responsibility for keeping your new family member supervised while with any child?
Yes
No
I understand that all information may be checked for authenticity. Per Large Breeds and Special Needs Rescue policy, a background check is required on all adopters and a home inspection must be completed before placement. All dogs placed by Large Breeds and Special Needs Rescue have received necessary medical care and vaccinations and have been tested to be free of heartworms and contagious disease at the expense of Large Breeds and Special Needs volunteers. I understand that I will be asked to give a donation of $375 to the Large Breeds and Special Needs Rescue to help with the spaying/neutering and veterinary care of current and/or future rescues.I understand that if, for any reason, I can no longer care for or keep the dog placed with me, I must return him/her directly to a Large Breeds and Special Needs Rescue member, and I will sign all necessary papers for the surrender of the dog.
Yes, I agree to all of the above
Submit
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