Name
*
First Name
Last Name
Date of Birth
*
Email Address
*
Mailing Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Are you applying for any specific dog or dogs? If so, which dog(s)?
*
Why do you want to adopt a pet?
*
What do you like most about having a pet?
*
What do you like least about having a pet?
*
Who are you adopting the pet for?
*
Who will be the primary caregiver of the pet?
*
Are you employed?
*
Occupation
*
Employer Address, City, State, Zip:
Work Phone Number:
(###)
###
####
How long have you worked here?
How long have you lived here?
*
If not a ground entrance, what floor?
Do you rent or own?
*
If you have no fenced yard, how will your pet relieve themselves/exercise?
Do you plan on moving in the foreseeable future? If so, where will you move and why?
*
Please list the names and ages of the adults with whom you live:
*
If you are adopting as a couple, how long have you been with your significant other?
Are you married?
Yes
No
Engaged
N/A
Please list the names and ages of any children with whom you live:
Are all members of your household aware of and in agreement with this adoption?
*
Yes
No
If no, what are their objections or concerns?
Does anyone in your home suffer from animal allergies?
*
What is your household activity level?
*
Do all of the adults work full time?
*
How many hours are you gone a day?
*
How many hours a day will your new pet be alone?
*
If you are working from home due to the pandemic, are you tentatively planning to return to working from an office? If yes, how many hours a day will your new pet be alone and what is your plan for their continued care?
*
If you have any companion animals currently in your home, please list their names, type of animal, gender, age and if they are spayed/neutered:
*
Has a previous pet ever run away?
*
Where will your new pet be kept when he/she is alone?
*
Where will your new pet be kept during the night?
*
Do you travel often?
*
Who will care for your pet when you travel? Please provide full names, phone numbers and email addresses:
*
Is a home visit okay?
Yes
No
Can you financially afford the medical care, training and other expenses associated with having a pet?
*
If you rent, does your lease allow pets?
Yes
No
N/A
Landlord Name:
Landlord Address and Phone Number:
Please provide the name, address and phone number of two (2) people not related to you but who can attest to your character and ability to have a pet:
*
Please provide your veterinarian's name, address and phone number:
*
How did you find out about Animal Lighthouse Rescue?
*
Please provide any other information that may be helpful for us to know when reviewing your application:
In connection with this adoption, we request a $600 donation fee to help us offset costs (it costs us nearly 3x this amount to rescue, rehabilitate, and transport each dog). Is this acceptable to you?
*
Yes
No
