Housing Type --Select-- House Condo Apartment Townhouse Dorm Mobile Home

Housing --Select-- Own Rent Live with Parents

How long have you lived at your current residence?

If you lease / rent your residence, please provide contact information for you landlord. We will need to verify current pet policy

Please list names/ages/occupation of all persons living in home

Does anyone in your household have allergies or asthma? Yes No

Who will be primarily responsible for the care of the dog?

How many hours will dog be left alone during the day? --Select--   0   1   2   3   4   5   6   7   8   9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

How will dog be contained when home alone?

Do you have a fenced Yard? Type? Height?

A new environment can be stressful for you and your pet and they may exhibit uncharacteristic behavior. How are you prepared to handle this should issues arise?

Most large breed dogs can take up to 2-3 years to mature, some can take longer. Is this something you are prepared for?

List any other pets in household.

Are your other pets microchipped with monitoring? --Select-- Yes No No Other Pets in Household

Are your other pets up to date on Vaccinations? --Select-- Yes No No Other Pets in Household

Do you have a regular Veterinarian? If so, please list contact information. PLEASE MAKE SURE THEY HAVE APPROVAL FROM YOU TO TALK WITH LOVE, HOPE & PAWS FOR A VET REFERENCE.

Do you intend to take dog for regular checkups, yearly vaccinations as well as maintain monthly heartworm and flea prevention? --Select-- Yes No

Under what circumstances would you NOT keep this dog?

I would enjoy brushing or grooming my dog : --Select-- Rarely Occasionally Daily Weekly Monthly

Please describe in detail your idea of the perfect pet for you family.

Energy level, adult size, grooming needs, temperment, etc.

Please list 3 References including phone number: (not family and not living with you)

Include Name and Phone number for each refrence

I agree should I adopt from LHPDR and later find I cannot keep the animal, he/she will be returned to Love, Hope & Paws Dog Rescue. All monies deposited with LHPDR will be considered a donation to the rescue and are non-refundable. --Select-- Yes, I agree to these terms. No, I do not agree to these terms

I acknowledge falsification of the above can result in me being denied adoption of an animal, or if adoption has already taken place, the animal being confiscated by Love Hope & Paws Dog Rescue. --Select-- Yes, I agree to these terms and verify all information is correct No, I do not agree to these terms

I certify that the above information is true and correct to the best of my knowledge --Select-- Yes No

I understand and agree that Love, Hope & Paws Dog Rescue makes no promises nor express or imply any warranty, representation or promise to the age, health, size, breed, habits, disposion or safety of the animal. I hereby accept the Animal as is, assume all risks and responsibilities associated with the ownership of the Animal, including potential bites, and I hereby fully and completely release, indemnify and hold harmless Love, Hope & Paws Dog Rescue, and its directors, officers, volunteers, servants and employees from any claim, cause of action or liability of any sort or nature, whether known or unknown, directly or indirectly arising out of or in connection with the adoption, care or ownership, maintenance, temperment or condition of the Animal.

Please type you full name as an electronic signature

*I have read and agree to the Terms and Conditions