LRW Adoption Application

Low Riders of the West Small Dog Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Low Riders of the West Small Dog Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.

This questionnaire is designed to help Low Riders of the West Small Dog Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to the meet. Low Riders of the West Small Dog Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.

If you are applying to adopt a puppy, please take a minute and read our Puppy Policy.

There are no exceptions to this policy.

Date

Name of the dog you are interested in: *

Your full name: *

Your age: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone:

Area Code Phone Number

Cell Phone: *

Area Code Phone Number

E-mail: *

Character reference and phone number: *

Why do you want to adopt a dog? *

Are all members of your household in agreement with this adoption? *

Yes No Don't Know

Who will be the pet's primary caregiver? *

Do you live in a *

House Apartment Condo Mobile Home

Do you own or rent? *

Own Rent

If rent, provide name and phone number of landlord:

Does your landlord allow dogs?

Yes No

Are there any restrictions from your landlord or subdivision? *

Number of pets Size or weight restrictions Breed restrictions None

Do you have a fully fenced yard? *

Yes No

Height and type of fence

How many adults are in your household? *

How many children are in your household? *

If children, what are their ages? *

Have your children been around animals before?

Yes No

Does anyone in your home have allergies to dogs or have asthma? *

Yes No

List any pets you own or have owned in the past five years, and their ages *

How many of these pets are spayed/neutered? *

Where are these animals now?

Have you adopted from an animal welfare group before?

Yes No

If yes, what group?

Have you ever given up a pet? *

Yes No

If yes, what were the circumstances?

Please provide the name and phone number of your current and/or previous veterinarian or clinic: *

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)

What level of dog experience describes you best?

Beginner Some Experienced Very Experienced

How many hours each day will your new pet be home alone? *

Where will your new dog stay when nobody is home? *

Where will your new pet sleep at night? *

How will you supervise the dog's outdoor activity? *

Have you ever house-broken a dog or puppy before? *

Yes No

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No

If you are applying for a puppy/dog who is not house trained, how will you house train the puppy/dog? *

Are you willing to work through your new pet's issues, if any? *

Yes No

If a behavioral problem arises, what steps will you take to work on it?

Do you have the time and resources to attend obedience/socialization classes with your new dog/puppy?

Yes Now

What changes will occur in your life if you adopt this dog?

What circumstances would lead you to give up your new dog? *

If you had to give up your dog, what would you do with him/her? *

If approved how soon will you be ready to bring your new dog home?

How did you find out about LowRiders Rescue? *

Rescue Website Adoptapet.com Petfinder.com Facebook Rescue Me Friend/Family Member

Please provide us with any additional information you would like include

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Low Riders of the West reserves the right to annual the adoption and reclaim the animal. I give the Partnership permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a Low Rider's volunteer before an adoption decision is made. In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is Low Riders' prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated by the Partnership, I am free to apply and undergo the application process in the future.

Signature

Clear

Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information