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Street Address: |
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City/State/Zip |
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Number of adults in household: |
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Name of spouse/significant other/roommate:
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Spouse's Age:
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Relationship to you:
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*Explain:
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Your Occupation:
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Spouses Occupation:
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If this relationship were to change, with whom would
the dog(s) remain?: |
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Who will be primarily responsible for the dog(s) care? |
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Do you have children? |
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Do they live with you? |
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Have they been around dog(s)? |
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List their ages: |
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If you do not have children now, are you planning a family
in the future? |
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If yes, when? |
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If you have children, are you planning to have more children
in the future? |
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If yes, when? |
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What are your reasons for adopting a dog(s)? |
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*Gift or Other/Explain: |
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What are the qualities you are looking for in a dog(s)? |
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Are you familiar with the characteristics/temperament
of this breed? |
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If yes, how so? |
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Does anyone in the household smoke? |
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Are you prepared to pay $40+ every 4-6 wks to groom your
dog(s)? |
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In your selection, what is your preference? |
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My ideal pet: |
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What concerns, if any, do you have about adopting? |
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HOME INFORMATION
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I consent to a home check in
the event my application is approved.
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Type of Dwelling: |
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Years at Residence:
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Do you have a Landlord/HOA? |
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If no, please explain: |
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Landlord/Owner/HOA (Name, Phone #) |
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Where will the dog(s) stay during the day: |
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Other, explain: |
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If the dog is indoors only, what access does he/she have
to outside? |
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How many hours a day will the dog(s) be left outside? |
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What outside space is available for the dog(s)? |
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If fenced yard, what type? |
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*Other: |
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Height: |
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Do you have a grassy area? |
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Do you have a pool? |
Is it fenced? |
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Other access areas for dog: |
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*Other: |
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Will the dog(s) be tied up? |
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Where will the dog sleep: |
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*Other/Explain: |
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Any areas where the dog(s) will not be allowed? |
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Are you planning a move in the next six months? |
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Please explain: |
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If you ever had to move, would your dog(s) move with
you? |
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PAST/PRESENT PET HISTORY
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When? (Please explain)
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Do you now own a dog(s)? |
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Number of dog(s) in household:
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Other animals in home:* |
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*If so, where are they housed? |
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History of dog guardianship/ownership (please
list each dog separately, list most recent dog first):
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Have your dog(s) been vaccinated? |
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Will you provide annual vaccinations? |
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If no or depends, please explain: |
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Will you provide necessary medical care? |
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If no or depends, please explain: |
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Veterinarian's name, phone number, address: (current
or most recent)
We must have this reference to process your application. |
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May Lhasa Happy Homes contact your veterinarian? |
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If no, please explain: |
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How many hours per day will your dog(s) be alone? |
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Explain: |
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Any provisions to let the dog(s) out during the day? |
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How many times will the dog(s) be walked each day? |
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How will your dog(s) spend the day? |
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Do you have a friend or relative* who would care for
the dog(s) if you became incapable of caring for him/her for an extended period
of time?
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Please provide name, relationship to you and their phone
number: |
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Lhasa Happy Homes reserves the right to approve individuals,
with no bias, for the protection of the dog(s).
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Will your dog(s) be allowed on the furniture? |
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Will you become frustrated if your dog(s) is not housebroken? |
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How do you plan on housebreaking your dog(s)**? |
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Please understand that even dogs that are housebroken
will go through an adjustment period.
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What would make you consider giving up your dog(s):
(check all that apply) |
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What would you do with your dog(s) if you could not keep
for any reason(s) listed above? |
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*Explain other: |
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If your dog(s) needed acute medical attention for an
illness or emergency care, are you prepared to handle the expenses? |
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If your dog developed an illness and required monthly
medication, up to what amount would you be comfortable in spending? (Please check
one response) |
*Other amount, please explain:
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Would you be willing to adopt a dog
that required monthly medication that costs under $50 a month? |
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If you currently have a dog, what brand of food are you
feeding him/her? |
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If a higher quality food was recommended
but is more expensive, would you be willing to change foods? |
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If no, please explain: |
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Have you ever trained a dog in obedience? |
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Would you agree to take this dog(s) to obedience school? |
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If the dog(s) becomes destructive, what would you do? |
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When your dog(s) disobeys, how do you reprimand? |
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Would you ever use a newspaper or object to reprimand
your dog(s) to stop bad behavior? |
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What would you do if your dog starting snapping or bit
at you or a family member? |
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*Other: |
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Will you be able to live with fur on your furniture,
stains on your rugs, a warm body on your bed, who may be destructive at times? |
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What would happen to this dog(s) if family situation
changed (divorce, relocation, death)? Please answer this question in detail. |
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Have you ever given away/sold or released an animal to
a shelter or rescue group? |
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If yes, why? |
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Have you ever been denied adoption by a shelter or other
rescue or humane group? |
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If so by whom? |
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Do you travel a lot? |
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Where will your dog(s) stay when you are traveling or
on vacation? |
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*Explain: |
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How did you hear about this group? |
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Please let us know who referred you so that we can thank
them! |
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Please briefly describe your lifestyle: (active, social,
homebodies, etc.) |
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How is your general health (health issues)? |
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Adopters over the age of 70 are required to have a co-adopter
in case of accident or death. If this applies to you, who would be your co adopter:
(name, address, phone number and relationship to adopter) |
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Please give three additional references. These may be
friends, co-workers and relatives. Please give name, relationship to you, email
address and phone number. |
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Additional pertinent information: |
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Additional pets information: |
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