Thank you for your interest in adopting a rescued animal!  

 

Please remember that adopting a pet is a lifetime commitment. 
(average dog life span is 12-15 years)

 

If you are human, leave this field blank.

Dog Application

LAPP DOG(S) INTERESTED IN: *

Must be 18yrs old or older to apply.

Date *

Name *

Address *

City *

Zip *

Home Phone *

Email *

Mobile Phone

Other Phone

Place Of Employment *

Please list all other persons in the home *

Who will be responsible for the dog? *

Reason for wanting a pet? *

Companion for selfCompanion for other petFamily PetGuard DogOther

Do you have a steady income to care for a dog? *

YesNo

When did you decide you wanted a pet? *

If checked Other, please explain:

Does anyone in your family have asthma, allergies, or other illnesses? *

YesNo

If Yes, please explain:

Where do you live? *

With parents

Apartment

Duplex

Mobile home

House

Other

Do you own or rent? *

Own

Rent

If you rent, please list landlords name/phone number:

Type of Dog you’re looking for: *

Where will your dog spend most of its time? *

Outside

Inside

Both

Do you have a fenced yard? *

YesNo

Dog pen? *

YesNo

Non-fenced land? *

YesNo

Do you own dog(s) at this time? *

YesNo

Are dog(s) on heartworm prevention? *

Yes

No

Which brand of heartworm prevention are you currently using? *

Pet #1

Dog or Cat?

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

How Long Owned?

Where is pet kept?

Pet #2

Dog or Cat?

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

How Long Owned

Where is pet kept?

Pet #3

Dog or Cat

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

How Long Owned

Where is pet kept?

Pet #1

Dog or Cat?

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

What happened to pet?

When?

Pet #2

Dog or Cat?

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

What happened to pet?

When?

Pet #3

Dog or Cat?

Dog

Cat

Name & Breed

Gender

Male

Female

Spay/Neutered

Yes

No

Age

What happened to pet?

When?

Who is your veterinarian?

Phone

How long have you used this vet?

On which animals?

I authorize a Lifeline representative to contact my veterinarian to obtain previous pet history

Yes

No

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