DOG ADOPTION APPLICATION
Applicant must be at least 21 years old
Applicant must live in the Los Angeles Area
Applicant's other cats/dogs must be neutered
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Did you read the preface to this application which explains our adoption criteria and process?
Yes, I read the preface
No, I did not read the preface
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If we choose to place a dog with you do you understand/agree to comply with our adoption process?
Yes, I understand and would comply.
No, I do not understand/do not agree to comply.
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Today's date:
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What dog do you want to adopt?
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First Name
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Last Name
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Street Address
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City
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State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
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Zip Code
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Do you own or rent?
Own
Rent
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How long have you been at your current residence?
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Home Phone:
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Cell Phone:
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Email Address
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Best way to reach you during the DAY:
Cell Phone
Home Phone
Work Phone
Email
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1. What is your Occupation:
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2. What is your age range:
Under 21 years
21-25 years
26-30 years
31-35 years
36-40 years
41-45 years
46-50 years
51-55 years
56-60 years
61-65 years
66-70 years
71-75 years
76-80 years
81-85 years
Over 85 years
3. Name of Spouse/Partner at residence:
4. Spouse/Partner Occupation:
5. What is your spouse/partners age range:
Under 21 years
21-25 years
26-30 years
31-35 years
36-40 years
41-45 years
46-50 years
51-55 years
56-60 years
61-65 years
66-70 years
71-75 years
76-80 years
81-85 years
Over 85 years
6. Other adults (21 or older) at residence. Please list name, age and relationship to you.
7. Name & AGE of children (21 years or younger) at residence.
8. If children live at your home, describe their experience with animals:
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9. Who is home during the day (you, other family member, housekeeper, etc.) What hours/days?
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10. If the person home during the day is not you, what would their responsibilities be with the dog?
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11. Is anyone at your home allergic to dogs?
Yes, one or more residents are allergic to dogs.
No residents are allergic to dogs.
I don't know if I/we are allergic to dogs.
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12. Will all household members be able to come meet the dog at our adoption fair?
Yes
No
I/we have already met the dog
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13. What is your level of experience with dogs?
Never had a dog as a child or adult (BEGINNER.)
I grew up with dogs, never had one of my own as an adult (INTERMEDIATE.)
Had at least one dog as adult and/or currently have a dog (ADVANCED.)
I consider myself an expert (EXPERT.)
14. If "expert" please explain your answer
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Indicates Response Required