Left Behind K-9 Rescue Adoption Application
City, State, Zip
What dog(s) or cat(s) are you interested in adopting?
# of Adults in Household
# of Children (17 and under)
List Ages of Children
Do other children visit your home? If so, how often?
Please list the ages of the children who visit
Are all of your family members in favor of adopting a rescue pet?
Who will be primarily responsible for the pet?
Is anyone in your home allergic to animals?
What type of dwelling do you live in? Do you rent or own?
If you rent, do you have landlord's permission to have a pet?
Provide name and phone # of landlord:
How long have you lived at your current address?
How many consecutive hours will the dog be left alone (N/A for cats)?
When you are not home, where will your rescue pet stay?
Will the pet be left indoors or outdoors?
Where will the pet sleep?
Would you be willing to allow us to visit your home prior to adoption?
Do you have a yard?
Is it fully fenced?
If you have pets currently, please list them below:
Please include: type of animal, age, sex, spayed/neutered, indoor/outdoor.
List all animals you have had in the past 5 years that are not listed above:
Please include: type of animal, age, sex, spayed/neutered, where is pet now?
Name of Vet:
Your Vet will be contacted as a reference.
Veterinary Clinic Address:
Veterinary Clinic Phone #:
Why do you want to adopt a rescue dog or cat?
Check all that apply
____ Companionship ____ Watch Dog ____ Company for my current pet(s) ____ Other, please explain
What activities do you plan on participating in with your new pet?
Are you planning on taking your new dog to an obedience class (N/A for cats)?
What circumstances, in your mind, justify giving a pet up?
Please check all that apply
____ Moving ____ Not getting along with other pets ____ Getting out of a fence ____ Too time consuming ____ Medical problems, allergies ____ New baby, kids lose interest ____ Divorce ____ Behavioral problems ____ Housebreaking problems ____ Financial ____ Other ____ No circumstance would justify giving a dog up
Have you ever given a pet up or had a pet for a brief period of time and it didn't work out?
If yes, please explain circumstances and what happened to it:
If your pet develops a medical problem that becomes expensive, what would you do?
____ Find another home for him/her ____ Pay whatever it takes ____ Give him to a rescue group or animal shelter ____ Other - please explain
Most pets can live upwards to 14 years, are you committed to care for it that long?
What are your training objectives (what commands would you expect your dog to learn)?
Please let us know anything else that would make you an ideal candidate for a rescue pet:
Send me a copy of my responses
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