PUPPY LOVE
PET RESCUE

DOG APPLICATION



Thank you for taking the time to complete this application for one of the animals in our care. We appreciate your honesty in answering all of the following questions. Review of your information will assist us in matching the appropriate companion to your lifestyle. Our main concern is the future health and well being of all the animals in our care.



**Submission of this application does not guarantee an adoption**





Name of dog you're interested in:

I am interested in adopting a pet   fostering a pet   volunteering my services


Last Name: First:

Address:

City:

State: Zip:

Phone(Home):

Phone(Work):

Phone(Cell):

Email:

May we contact you in regards to upcoming events and promotions? Yes No

How did you hear about Puppy Love Animal Rescue?
(Please choose all that apply)

Internet Newspaper Petco/PETsMART
Friend/Relative/Other Adopted from Puppy Love before

Age of Applicant?


1. Who will be responsible for the dog?

2. Have you ever had a pet before? Yes No
If yes, please fill in all details below:

Pet#1 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

Pet#2 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

Pet#3 name: Type: Age:
Owned from / / to / /
Reason pet is no longer in your care:

3. Do you live with other pets at home? Yes No
If yes, please complete the following:

Pet#1 name: Type: Altered/Neutered? Yes No

Vaccinated against:
a. Rabies? Yes No
b. Distemper? Yes No
c. Heartworm? Yes No

Tested for:
a. FIV? Negative Positive
b. FeLv?Negative Positive
Where Kept?

Pet#2 name: Type: Altered/Neutered? Yes No

Vaccinated against:
a. Rabies? Yes No
b. Distemper? Yes No
c. Heartworm? Yes No

Tested for:
a. FIV? Negative Positive
b. FeLv?Negative Positive
Where Kept?

Pet#3 name: Type: Altered/Neutered? Yes No

Vaccinated against:
a. Rabies? Yes No
b. Distemper? Yes No
c. Heartworm? Yes No

Tested for:
a. FIV? Negative Positive
b. FeLv?Negative Positive
Where Kept?

Pet#4 name: Type: Altered/Neutered? Yes No

Vaccinated against:
a. Rabies? Yes No
b. Distemper? Yes No
c. Heartworm? Yes No

Tested for:
a. FIV? Negative Positive
b. FeLv?Negative Positive
Where Kept?

4. How often do you take your pet to the Veterinarian?
If "other" is selected, please explain:

a. Date of last visit? / /
b. Name of Vet?
(Please list a Vet you've frequented in the past if you aren't using one presently.)
c. Address: City: State: Zip:
d. Vet's phone number? - -

5. I live in a

a. Rent or Own? Rent Own
b. Landlord's name?
c. Landlord's phone number? - -

6. How long have you lived at your current address?

7. How may people live in your household?
Please fill in the information below:
a. Name: Adult Child    Age:
b. Name: Adult Child    Age:
c. Name: Adult Child    Age:
d. Name: Adult Child    Age:
e. Name: Adult Child    Age:

8. What is the longest period of time the dog will be left alone?

a. Where will the dog be kept during this time?
b. Where will the dog be kept when the family is home?
c. What would you do if your pet chews the furniture or displays other destructive behavior?

9. What is your reason for adopting this dog?
      (Please choose all that apply)

House Pet Guard Dog Watch Dog
Companion Pet Companion Backyard Pet
Gift Breeder Other
If "other" was selected, please explain:

10. Please choose yes or no for the following questions:
a. Are you familiar with housebreaking? Yes No
b. Are you familiar with crate training? Yes No
c. Are you familiar with licensing laws in your community? Yes No

11. Does your yard have a fence? Yes No   If yes, how high?    Type:

12. Are you willing to agree to a home evaluation during the 7-day waiting period? Yes No

13. Are you willing to agree to 3-month, 6-month and yearly follow up visits? Yes No

14. Please provide one personal reference who can recommend you as a responsible pet owner:
Name:
Phone: - -
Relationship to applicant:

15. Please provide any additional information you feel pertinent to the adoption in the adjacent field.

By submitting this application, you certify that you understand and agree to the following:

§   Puppy Love Pet Rescue representatives may contact anyone listed on this form.
§   You have answered all questions honestly and accurately.
§   Puppy Love Pet Rescue reserves the right to refuse any adoption without further explanation.