PLEASE FILL OUT COMPLETELY. INCOMPLETE QUESTIONNAIRES WILL NOT BE PROCESSED
Do not hit enter/return. Your web browser will send an incomplete application and you will have to start over. After answering all of the questions, click the submit button on the bottom of the form.
1. Your Name: Spouse/Significant Other Name:
2. Address: City: State: Zip: Phone: Day Evening E-mail address:
3. Children and Ages:
4. Number of pets owned now: Dogs:Cats:Other: Are they spayed/neutered? Yes No Current on rabies vaccinations? Yes No Current on other vaccinations? Yes No Current on heartworm prevention? Yes No What brand of preventative do you prefer? Do you use a flea preventative? Yes No If yes, what type of flea preventative do you use?
5. Pets owned in past and what happened to them:
6. Vet reference: Can we call your vet? Yes No Name Phone
7. Personal reference: Name Phone
8. Do you work or stay at home?
9. Employer Name How long Address City: State: Zip: Phone
10. Do you have a fence? Yes No Please describe the type and size:
11. Do you rent or own?
12. If in an apartment, do they allow pets and if so, do they have a limit on size or require a pet deposit?
13. Where will you keep your dog: Inside Outside Both
14. Where will your dog sleep?
15. Do you believe in crating your dog? Yes No
16. Who will take care of your dog when you work or travel?
17. How many hours will your dog be alone during the day?
18. Why do you want a rescue dog?
By signing below, Applicant certifies that the above information is true and understands that, prior to being approved for adoption, this information will be verified. A home visit will be scheduled and all members of the household must be present.Applicant certifies that he/she is financially and physically able to care for the animal. Applicant understands that proper food and vet care can be costly and is prepared to meet these requirements. The adopted Rottweiler will be spayed/neutered, current on vaccinations and on heartworm preventive medication prior to placement. Approved adoptions require a signed Adoption Contract. The Adopter will also make an adoption payment to LaP Dog Rescue upon taking possession of the dog. LaP Dog Rescue reserves the right to make future visits to ensure the adopted dog is being properly cared for, and if it is not, to remove the dog from the premises without refund.
LaP Dog Rescue reserves the right to decline any application.
"I/we hereby state that neither I/we nor anyone in my/our household, nor anyone who will have access to or care for this dog, has ever been charged with or convicted of any offense involving animal neglect, abuse, or cruelty, regardless of any dismissal or deferred prosecution or other expunging of the records. I/we understand and agree that if this statement is found to be incorrect, without further evidence of any other contract violation, the Rescue may immediately obtain return of all animals adopted to me/us, without refund of any sums paid, donated, or expenses incurred. Further, it is agreed that I/we shall pay all costs of the recovery and return of said dog(s) incurred by said Rescue."
Signature: