Relation to Applicant:
Address, City, State and Zip
Phone No. (w/ area code)
Who will be responsible for this animal?
Do you live in a:
If renting, does your landlord allow pets:
N/A - not renting
Landlord Name & Phone No (w/ area code):
How long have you lived at your present address?
Do you plan on moving in the next 6 months?
If you move in the future, what will you do with the dog?
Do you have children at the home?
If yes, what are their ages?
Are they used to animals?
Do you plan on having children in the next 10 years?
Is anyone in the household allergic?
How would you describe your lifestyle?
Why do you want this dog?
Companion for kids
Companion for other dog
Other (please specify)
Please provide the following information for each of your current pets: (Name, Breed/Species, Age, Sex, Time Owned, Spayed/Neutered):
Are your pets current on all vaccinations?
N/A - no other pets
Vetarinarian Name, Vet License No., and Phone No. (w/ area cde)
How many hours a day will this pet be alone on a typical workday (without human)?
When the dog is home alone, where will the dog be kept?
Run of house
Access to dog door
Outside Kennel with doghouse
Other (please specify)
Will this dog be allowed indoors?
Where will this dog sleep?
When outside, this dog will be:
In a fenced in yard
On a leash
Trained to stay in boundary
Other (Please specify)
If yard is fenced, will it safetly contain this animal?
N/A - not fenced
Type of fence?
What kind of outside shelter will be provided?
Are you willing to enroll this dog in obediance classes?
Are you willing to put in the time to housetrain a dog?
Are you aware of your local animal control regulations?
Is your dog licensed?
N/A - no other dog
Will you license this dog?
How many pets (exluding those listed above) have you owned in the last 5 years?
What happened to them?
As part of our adoption process we require a home visit. Will you allow a home visit?
Are you aware of the financial committment and responsibilities in owning a companion animal?
PLEASE PROVIDE THREE (3) REFERENCES: One reference can be a family member. Other references may include neighbors, co‐workers, or friends.
Reference #1: Name / Relationship / Phone No. (w/ area code)
Reference #2: Name / Relationship / Phone No. (w/ area code)
Reference #3: Name / Relationship / Phone No. (w/ area code)
In the past 30 days, have you applied for a dog at another animal shelter or rescue? If yes, where?
Please provide any additional information you would like to share or explain any above answers here:
Are you interested in a specific adoptable dog? If so please indicate name here:
If you are not applying for a specific dog, please indicate preferences here (breed/color, sex, age, level of activity, etc.):
Have you previously adopted from The Last Dog Rescue? If so, who/when?
How did you hear about us?
By submitting this application, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal from The Last Dog Rescue. This dog will reside in my home as a pet. I will provide it with adequate food, water, shelter, training, affection and medical care. If the dog is not spayed/neutered at the time of adoption due to age, I agree to spay or neuter the dog as soon as medically necessary and forward evidence of such to The Last Dog Rescue by the date requested. I agree to return the dog to The Last Dog Rescue if I am no longer able to care for the dog .I am in full agreement with these terms of adoption. The Last Dog Rescue is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog in my household. I understand that there is a $325 adoption donation to help offset pulling fees and vet fees. Additional transportation costs may apply based on my location.