Lost Dog Search & Rescue Adoption Application

Lost Dog Search & Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. The Lost Dog Search & Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for some by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering prior to their adoption.

This questionnaire is designed to help Lost Dog Search & Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Lost Dog Search & Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Name of the dog you are interested in:

Your full name:

Your Age

Street Address:

City, State, Zip

Home Phone:

- Area Code Phone Number

Work Phone:

- Area Code Phone Number

Cell Phone:

- Area Code Phone Number

E-mail:

Employer:

Character reference Name, address, phone number: and relationship

Are all members of your household in agreement with this adoption?

Yes No Don't Know

Who will be the pet's primary caregiver?

Number of hours the dog will spend alone

Do you live in a

House Apartment Condo Mobile Home

Do you own or rent?

Own Rent

If rent, provide name and phone number of landlord:

Does your landlord allow dogs?

Yes No

Are there any restrictions from your landlord or subdivision?

Number of pets Size or weight restrictions Breed restrictions None

Do you have a fully fenced yard?

Yes No

Height and type of fence

Do you have any of the following?

Underground fence Kennel Dog Run

How many adults in your household?

How many children in your household?

If children, what are their ages?

Have your children been around animals before?

Yes No

Does anyone in your home have allergies to dogs or have asthma?

Yes No

List any pets you own or have owned in the past five years, and their ages

How many of these pets are spayed/neutered?

Where are these animals now?

Have you ever given up a pet?

Yes No

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic:

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)

Have you ever house-broken a dog or puppy before?

Yes No

If the dog has an "accident" in your home, what type of correction do you plan to use?

How many hours each day will your new pet be home alone?

Where will your new pet sleep at night?

How will you supervise the dog's outdoor activity?

Where will your new dog stay when nobody is home?

Are you willing to work through your new pet's issues, if any?

Yes No

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?

Yes No

If for any reason you had to give up your pet do you agree to return it back to the Lost Dog Search & Rescue Group *

Yes No

Do you agree: All information is true and complete. This dog will reside in my home as a pet. I will provide it with quality food, fresh water and indoor shelter. I also agree to provide the dog with annual physical examinations and vaccinations under the supervision of a licensed Veterinarian *

Yes No

Are you willing to let a representative of the Lost Dog Search & Rescue visit your home by appointment *

Yes No

I understand that I assume full responsibility for the welfare of this pet from the date of adoption and everything that is stated is the truth. (Failure from being truthful will forfeit the ownership of the dog at any time and the dog will immediately be returned to the Lost Dog Search & Rescue)

Lost Dog Search & Rescue

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information