Legacy Dog Rescue of Ohio, Inc Adoption Application
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Name of dog requesting for adoption:
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Name of applicant:
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Street address:
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City, state & zip code:
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Home phone/cell phone:
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Age & occupation:
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Email address:
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Are all adults currently living in this home in agreement on bringing a new dog into the home? Provide name of spouse/roomate:
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Spouse/Roomate Age & Occupation:
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Please indicate your living environment: apartment, house, condo, townhouse or mobile home
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Number of adults living in household:
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Are there children in the household? If yes, please state ages and gender:
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Do you own or rent your home? If you rent, are you permitted to own a dog?
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If you rent, please provide name & phone number of your landlord (write N/A if you own):
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If you rent, please provide amount of rental deposit, if any (write N/A if you own):
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Please list any questions or concerns about this dog:
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As part of the adoption process, a home visit is required before or at the time of placement of the dog. Are you willing to permit a representative of Legacy Dog Rescue of Ohio, Inc to visit your home?
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Please list the reason(s) you are interested in adopting this dog:
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What major life changes do you forsee in the next 15 years? marriage, childbirth, health issues or other.
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Can you provide a permanent home for the duration of the dog's life?
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Is your yard fenced? If yes, what is the height and type of fence?
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Please list current pets (number, type and age):
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How many dogs have you owned in the past 15 years?
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If you no longer have these dogs, could you explain why (ex deceased, rehome)?
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Were all previous and current pets spayed or neutered? Were your previous pets kept on some type of monthly heartworm preventative? Will you keep a dog that you would adopt from our rescue on monthly heartworm preventative? If no, please explain.
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Do any of your previous or current pets live primarily outdoors?
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How many hours will the dog be home alone on a typical day?
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Where will the dog stay in the home when alone on a typical day? ex: crate, loose inside home, outside or other, please explain:
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Where will dog sleep at night? crate, loose in house, outside or other, please explain:
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Have you ever previously surrendered a dog or cat to a shelter or pound?
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Which of the following circumstances, in your mind, justify giving up a dog? moving, new baby, divorce, escaping fence, behavioral problems, shedding, loss of interest, time consumption, allergies, size of dog, housbreaking, medical problems, aggression, unwanted chewing, not getting along with other pets or other, please explain:
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If this dog is placed in your own and subsequently the adoption is finalized, do you agree that if you must later surrender this dog, you will only surrender to a representative of Legacy Dog Rescue of Ohio, Inc?
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Provide name, address and phone number of your current veterinarian. If you do not currently have one, please explain why. (Note: at time of placement a veterinarian practice in your area must be identified, that can provide full-service, not just spay/neuter service).
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May we contact your veterinarian for a reference?
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Release
I accept the the animal as is and assume all risk of ownership, including risk of injury or damage caused by the animal. On behalf of heirs, my personal representatives. assigns and myself, I hereby release Legacy Dog Rescue of Ohio, Inc , its directors, officers and agents from any and all claims, cause of action and demands of any nature, whether known or unknown, arising out of or in connection with my adoption.
By signing and dating below, I attest that my answers were truthful to best of my knowledge. I understand falsification of any given information will be grounds for disallowing the adoption of a Legacy Dog Rescue of Ohio, Inc dog and likely removal of said dog from the home. I further state that I am 18 years of age or older and fully understand Legacy Dog Rescue of Ohio, Inc reserves the right to refuse any applicant without providing reason.
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