Dog Adoption Questionnaire

Thank you for choosing to adopt a dog. We are so excited to help find you a forever family member. When looking for a dog we encourage you to ask lots of questions, meet lots of dogs, and have fun! Incomplete questionnaires or forms without accurate contact information will not be processed. Once you submit the application, our Dog Program Coordinator will be in touch with you via email. Please be sure to check your spam/junk folder as well as your regular inbox, as our communications can sometimes end up in junk folders. We look forward to chatting with you!

First Name *
Last Name *
Co-Applicant First Name
Co-Applicant Last Name
Physical Address *
City
State *
Zipcode *
Email *
Secondary Phone
Primary Phone *
Do you Rent or Own *	Please Choose Rent Own
Landlord or Property Management Name *
Landlord or Propery Management Phone Number *
How Many Adults in the home *
How many Children in the Home *
Ages of Children in home
Dog/Dog's you are interested in (specific dogs may not be available):
I am interested in: *	Adult Puppy Senior
Preferred Size *	Small(Under 20lbs) Medium(30lbs-50lbs) Large(Over 50lbs)
I am looking for a companion to: * What are you hoping your animal will like to do? eg. Hike, Play with my current dog, Cuddle on the couch
Where will your dog spend their day? * What is your preferred set up? eg. In a kennel, Indoors, Outside
Where will your dog spend their night? * What is your preferred set up? eg. In a kennel, Indoors, Outside
Please tell us about past animals- Include Name of Pet, Type & Breed, Age, Gender, Whether they are Spayed/Neutered, and anything about their personality * If you have no past animals put N/A
Please tell us about current animals- Include Name of Pet, Type & Breed, Age, Gender, Whether they are Spayed/Neutered, and anything about their personality * If you don't have any current animals please write N/A
Current Veterinarian *
Do you have any questions for the Adoption counselors or is there anything you would like to let them know?
Applicant Signature *	Clear
Co-Applicant Signature	Clear

By signing, I certify that the following information I have given is true. I understand that LCHS reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application and verify that I am at least 18 years old. By signing I am stating that I am financially able to care for this animal. I understand that proper food, water, and veterinary care can be costly and I have read and am able to meet these requirements. I also understand that in some cases a home visit may be mandatory prior to completing the adoption. I understand that any false statements either made verbally to adoption counselor or other associated staff member may constitute grounds for confiscation and surrender of the animal to LCHS. I further understand and agree that LCHS may demand the return or the animal for any violation of the terms of adoption contract and agreement. Finally, I understand that completing this questionnaire does not guarantee that LCHS will adopt the animal to me, and that adoptions are approved based on the best available home and are not necessarily processed in the order they were received.