Home Style:	House Semi-Detached Townhouse Townhouse style condominium Apartment Apartment style condominium Mobile Home Other		If 'Other', Please Describe:
Do You:	Rent Own Other		If 'Other', Please Describe:
If renting, Landlord's Name:			Landlord's Phone Number:
Environment Type:	City Suburban Country		Number of years there:
Home Sq. Footage:			Approx Yard Size:
Is there a part of your home the dog will not have access to?	No Yes		If yes, please explain:
Is your yard fully fenced and secure enough to contain any dog?	No Yes		If yes, describe the fence (height, secured underground, invisible, etc.):
Is there a gate?	No Yes		If yes, can it be locked:	No Yes
If there is no fence and gate, please describe how you will keep your dog secure on your property:
Do you have a pool?	No Yes		Is the pool separately fenced?	No Yes
Is someone home during the day?	No Yes		Where will your dog be kept during the day?
Where will your dog be kept during the night?			How many working hours will your dog be left alone in a day?
How often do you go away on holidays?			Where would the dog stay during holidays?
Will you have a dog run/dog house?	No Yes		Under what conditions would you use it?
Will you take your dog to obedience class?	No Yes		Which trainer do you plan to use?
What activities do you plan to do with your dog?			Who will be the primary caregiver of the dog?

Which of the following best describes the dog that you are looking for?
Age	Baby (0 - 6 months) Puppy (6 mos - 1 year) Teen (1 - 2 years) adult (2 - 7 years) Senior (8+ years) No Preference		Size	Toy (< 10 lbs) Small (11 - 25lbs) Medium (26 - 60lbs) Large (> 60lbs) No Preference
Activity Level	Minimal Moderate Active Very Active No Preference		Coat	Smooth coat Short Medium Long No Preference
Gender	Female Male No Preference
Personality attributes that you are looking for in a dog, such as bold, passive, quiet, active:
Do you have a breed preference? If so, please list.			Have you ever owned this breed before?	No Yes
Are you prepared to have regular grooming done if the breed requires it?				No Yes
Have you ever owned a dog before?	No Yes		If so, where is that dog now?
Do you have any other pets?	No Yes		If yes, please list type, breed, age, sex
List other pets you have owned in the past 10 years and what happened to them:			Where did your current and previous pets come from?
Are your pets current on all vaccinations?	No Yes		Approx date of pet(s) last vet visit:
Are your other pets spayed/neutered?				No Yes
Do you use heartworm prevention with your other pets?				No Yes
If so, what type?			If not, why not?
What do you plan to feed your dog?
Maximum amount you would spend for a medical treatment to maintain a good quality of life for your dog?
How many years do you plan to keep the dog?
Do you plan to get pet insurance?				No Yes Maybe
Who would immediately care for your adopted dog should you become ill or die suddenly?
Why do you want a rescued dog?
Under what circumstances would you give up the dog?		Are there any specific behaviors that the dog may exhibit that would prompt you to give it up?

How did you hear about LOYAL Rescue?		Friend/Family PetFinder Internet Search Social Media Event - please specify Other - please specify	Have you applied to adopt a pet with any other organizations or rescues in the past year?	No Yes
Specifically:			List any humane societies, organizations, breed or training clubs you are associated with:
We will attempt to provide you with an honest evaluation of the temperament on any dog we have to place. Do you realize that at often times the complete history of a rescue dog may not be known and you may encounter some behavioral problems?				No Yes
Are you willing to work with us on correcting these problems?				No Yes

References

Please provide the name, relationship to you, phone number and email of three personal references (maximum of one family member) as well as your veterinary reference. If you have no previous veterinary history, please include a fourth reference (not a family member).

Veterinarian (or extra Reference if you have no previous animal ownership)

Name:			Relationship:
Phone:			Email:

Reference 1

Name:			Relationship:
Phone:			Email:

Reference 2

Name:			Relationship:
Phone:			Email:

Reference 3

Name:			Relationship:
Phone:			Email:

I have already advised my Veterinarian and personal references that a volunteer from LOYAL Rescue Inc. will be contacting them.	No Yes
I am aware that a fixed adoption donation and a signed adoption agreement apply, should I be the successful applicant, and that a hard copy of my signature is required at the point of adoption, certifying all information.	No Yes
I certify that the information provided on this form is true and correct and that nothing of relevance has been omitted. I realize that if any of the information I have provided is inaccurate, misleading, or significant omissions have been made, this may result in my application being denied. I grant my permission for a LOYAL Rescue volunteer to contact all stated personal references and veterinarian(s). I am financially and physically able to care for this animal. I understand that proper food, water, shelter, and veterinary care is necessary and may be costly, and I am able to meet these requirements. I am aware that Home Visits are mandatory prior to approval for ALL applicants and are also made on a random basis following adoption. If, even after an adoption has taken place, it is discovered that information contained in this application is false or misleading, LOYAL Rescue retains the right to deny your application or remove the animal from your premises without a refund of monies paid. LOYAL Rescue reserves the right to deny any application due to the primary interest being the best interest of the animal.
I Agree to the above statements and I certify that I am 18 years or older
Enter Security Code: