Adoption Application Contact Information *All fields are required. Full Name Street Address City, State, Zip Daytime Phone Evening Phone Cell Phone Email Address If you have adopted from us before, please list the dog’s rescue name, and the full name of the adopter (if different from above) Please Tell Us About Your Household Do you currently own or rent your current residence? Own Rent Please select an option Please list the names AND the ages of every person who lives in the home To help us match animal personalities, please list all of the animals currently in your home, how long you have had these animals, the gender, and ages of the animals List the animals you cared for in the past five years, how many years they lived with you, and where they are now. Please do not include animals currently in your care Have any of the above animals (past or present) ever been unaltered (not spayed or neutered)? Yes No Please select an option If yes, please explain The Companion Animal If there is a particular Lucky Dog companion in whom you are interested, what is the name of the dog? How would you describe your household activity level? Is the animal to be a gift, or a surprise? Yes No Please select an option If yes, for whom? How long have you been thinking of adopting? Have all adults in the home agreed to adopt? Yes No Please select an option Animal Care Which person will be the primary care giver for this animal, and what will their responsibilities be? How many hours a week is the primary caregiver at work and away from the home? Does anyone in your home suffer from allergies and/or asthma? Yes No Please select an option If yes, please elaborate how will the dog affect that household member? If your answer is that there will be no effect, please explain why. What would you do if your work hours were to increase? If the dog will be alone for extended periods during the day, exactly how will you arrange for the dog to be safe/have its bathroom needs met/have some companionship during the time while you are at work? Where will the animal stay when you are home? Inside Outside Both Please select an option Where will the animal stay when you are away? Inside Outside Both Please select an option Where will the animal stay at night? Inside Outside Both Please select an option Do you have a doggy door? Yes No Please select an option Are you willing and able to accept full care, costs, and necessary burdens and responsibility of owning a dog? Yes No Please select an option Before returning the animal, would you consult a Lucky Dog volunteer or seek the help of a behavioralist? Yes No Please select an option If you were to move, what would you do with your pets? Have you ever surrendered an animal to the Humane Society, the Pound or Animal Care & Control? Yes No Please select an option If yes, please explain Have you ever placed a pet with family, friend or acquaintance? Yes No Please select an option If yes, please explain the circumstances References Reference 1 Name Reference 1 Phone Reference 2 Name Reference 2 Phone Submitting...
