LOYAL Rescue Inc. Dog Adoption Application

Please fill in as much information as possible in each tab. If the application is not complete, we cannot consider you for one of our dogs. Adopting a rescued dog is a serious endeavor and should not be done as a "spur of the moment" action.

All YELLOW areas are mandatory. We need to know you as well as we can so please provide us with information that is as accurate possible. Most of these questions do not have "right" or "wrong" answers. They are a way for us to verify that the dog you have selected would be well suited to your home and lifestyle. Frequently Asked Questions about adoption.

• About You
• Your Lifestyle
• Pet Information
• Other Information

Name of the dog on the LOYAL Rescue Inc. website you are applying for:
I understand that this application form is not a guarantee that the dog I have applied for will still be available if my application to adopt a dog is approved, as there could be several applications for this dog already in progress or the dog may have a requirement that my home does not provide.					No Yes
I understand that LOYAL Rescue Inc. does not approve their dogs to applicants on a "first come first serve" basis, it is the best interest of the dog that is considered in the event of multiple applications for the same dog and the home best suited to the specific needs of the dog will be selected.					No Yes
In the event that the dog I have applied for is approved to another adopter before my application is processed I will select another dog from the LOYAL Rescue Inc. website and continue with my application screening.					No Yes
I understand and accept that virtually all "rescued" dogs will have behavioral issues of varying degrees. Many of these dogs have been abused or neglected and have a tendency to be more timid and/or defensive than a dog raised from birth by a knowledgeable and responsible dog owner. I understand and accept that while all known behavioral issues will be disclosed prior to the adoption being completed, it is entirely possible that minor or major behavioral issues may arise after the adoption has occurred and the dog is in my home. I am not expecting a pre-trained dog and am willing to work with this dog to help it overcome any issues it may have, or develops while under my care.					No Yes
I understand and accept that although all LOYAL Rescue Inc. dogs have been evaluated by a veterinarian, and that a copy of the veterinarian's report(s) will be provided at the time of adoption, it is possible that the dog may have minor or major medical issues that are undiagnosed. I understand and accept that the approximate age of the dog is estimated by a veterinarian and may be slightly or significantly inaccurate.					No Yes
I have verfied that this dog is being fostered in a location close enough for me to personally travel to, in order to adopt this dog, should I be the approved adopter.					No Yes
I have thoroughly read and understand the information in the FAQ section of the LOYAL Rescue Inc. website.					No Yes
First & Last Name:			Your Age:
Partner's First & Last Name:			Partner's Age:
Address:			City:
Prov/State:			Postal/Zip Code:
Email Address:			Alternative Email:
Primary Phone#:			Type:	Home Cell Work Other
Alternative Phone#:			Type:	Home Cell Work Other
Best time to call:			Can we call you at work?	No Yes
Your Employer:			Phone:
Job Title:			Employed Since:
Spouse Employer:			Phone:
Job Title:			Employed Since:
Number of children:			Gender:	Female Male Both
Ages:			Does anyone have any allergies? If so, please explain:
Total number of people residing in home:			Age(s) of any not already specified:

Home Style:	House Semi-Detatch Townhouse Townhouse style condominium Apartment Apartment style condominium Mobile Home Other		If 'Other', Please Describe:
Do You:	Rent Own Other		If 'Other', Please Describe:
If renting, Landlord's Name:			Landlord's Phone Number:
Environment Type:	City Suburban Country		Number of years there:
Home Sq. Footage:			Approx Yard Size:
Is there a part of your home the dog will not have access to?	No Yes		If yes, please explain:
Is your yard fully fenced and secure enough to contain any dog?	No Yes		If yes, describe the fence (height, secured underground, invisible, etc.):
Is there a gate?	No Yes		If yes, can it be locked:	No Yes
If there is no fence and gate, please describe how you will keep your dog secure on your property:
Is someone home during the day?	No Yes		Where will your dog be kept during the day?
Where will your dog be kept during the night?			How many working hours will your dog be left alone in a day?
How often do you go away on holidays?			Where would the dog stay during holidays?
Will you have a dog run/dog house?	No Yes		Under what conditions would you use it?
Will you take your dog to obedience class?	No Yes		Which trainer do you plan to use?
What activities do you plan to do with your dog?			Who will be the primary caregiver of the dog?

Which of the following best describes the dog that you are looking for?
Age	Baby (0 - 6 months) Puppy (6 mos - 1 year) Teen (1 - 2 years) adult (2 - 7 years) Senior (8+ years) No Preference		Size	Toy (< 10 lbs) Small (11 - 25lbs) Medium (26 - 60lbs) Large (> 60lbs) No Preference
Activity Level	Minimal Moderate Active Very Active No Preference		Coat	Smooth coat Short Medium Long No Preference
Gender	Female Male No Preference
Personality attributes that you are looking for in a dog, such as bold, passive, quiet, active:
Do you have a breed preference? If so, please list.			Have you ever owned this breed before?	No Yes
Are you prepared to have regular grooming done if the breed requires it?				No Yes
Have you ever owned a dog before?	No Yes		If so, where is that dog now?
Do you have any other pets?	No Yes		If yes, please list type, breed, age, sex
List other pets you have owned in the past 10 years and what happened to them:			Where did your current and previous pets come from?
Are your pets current on all vaccinations?	No Yes		Approx date of pet(s) last vet visit:
Are your other pets spayed/neutered?				No Yes
Do you use heartworm prevention with your other pets?				No Yes
If so, what type?			If not, why not?
What do you plan to feed your dog?
Maximum amount you would spend for a medical treatment to maintain a good quality of life for your dog?
How many years do you plan to keep the dog?
Do you plan to get pet insurance?				No Yes Maybe
Who would immediately care for your adopted dog should you become ill or die suddenly?
Why do you want a rescued dog?
Under what circumstances would you give up the dog?		Are there any specific behaviors that the dog may exhibit that would prompt you to give it up?

How did you hear about LOYAL Rescue Inc.?			Have you applied to adopt a pet with any other organizations or rescues in the past year?	No Yes
List any humane societies, organizations, breed or training clubs you are associated with:
We will attempt to provide you with an honest evaluation of the temperament on any dog we have to place. Do you realize that at often times the complete history of a rescue dog may not be known and you may encounter some behavioral problems?				No Yes
Are you willing to work with us on correcting these problems?				No Yes

References

Please provide the name, relationship to you, phone number and email of three personal references (maximum of one family member) as well as your veterinary reference. If you have no previous veterinary history, please include a fourth reference (not a family member).

Veterinarian (or extra Reference if you have no previous animal ownership)

Name:			Relationship:
Phone:			Email:

Reference 1

Name:			Relationship:
Phone:			Email:

Reference 2

Name:			Relationship:
Phone:			Email:

Reference 3

Name:			Relationship:
Phone:			Email:

I have already advised my Veterinarian and personal references that a volunteer from LOYAL Rescue Inc. will be contacting them.	No Yes
I am aware that a fixed adoption donation and a signed adoption agreement apply, should I be the successful applicant, and that a hard copy of my signature is required at the point of adoption, certifying all information.	No Yes
I certify that the information provided on this form is true & correct and that nothing of relevance has been omitted. I realize that if any of the information I have provided is inaccurate, misleading, or significant omissions have been made, this may result in my application being denied. I grant my permission for a LOYAL Rescue Inc. volunteer to contact all stated personal references and veterinarian(s). I am financially and physically able to care for this animal. I understand that proper food, water, shelter, and veterinary care is necessary and may be costly, and I am able to meet these requirements. I am aware that Home Visits are mandatory prior to approval for ALL applicants and are also made on a random basis following adoption. If, even after an adoption has taken place, it is discovered that information contained in this application to be false or misleading, LOYAL Rescue Inc. retains the right to deny your application or remove the animal from your premises without a refund of monies paid. LOYAL Rescue Inc. reserves the right to deny any application due to the primary interest being the best interest of the animal.
I Agree to the above statements and I certify that I am 18 years or older
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