LOVING TOUCH P.O BOX 650404 FLUSHING, NY 11365 DOG ADOPTION APPLICATION
Note: Please read this application, fill in the blanks, and return it to us via e-mail OR print it out, fill it out and mail to the address above. The information you provide on this application and during our interview will help us determine whether the dog that you have chosen is indeed a good match for you. Incomplete applications will NOT be considered, so PLEASE take the time to respond to EACH and EVERY question. Please use the TAB key to move from field to field.
Items marked with an * are required fields, and this form will not process without them.
Some people have been having problems with the application, so you might want to as a precaution PRINT OUT A COPY OF THE APPLICATION, that way if there is a problem sending it you will have a printed copy you can fill out and snail mail to us. Make sure you have filled out ALL of the required fields, it will not send electronically if you haven't. If you are having a problem with the application, just send the printed, filled out copy to: --------------------------------------> And email me with a description of the exact error message you might have received so I can fix the problem, thank you for your cooperation and patience in this matter. LOVING TOUCH P.O BOX 650404 FLUSHING, NY 11365
General Information
Today's Date*:
Interested in which dog?*:
First Name*:
Last Name*:
Email Address*:
Home Phone*:
Work Phone:
Street Address*:
City*:
State*:
Alabama
Alaska
Arizona
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Colorado
Connecticut
Delaware
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Hawaii
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Illinois
Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Nevada
New Hampshire
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New Mexico
New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhoda Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington, DC
West Virginia
Wisconsin
Wyoming
Zip Code*:
Is applicant over age 21? Yes No
Home Information
Which of the following best describes your current residence?
Own a Single Family Home
Own a Town House or Condominium
Own a Duplex
Own a Farm
Rent/Lease a Single Family Home
Rent/Lease a Duplex
Rent/Lease an Apartment/Condo
If you rent, are pets permitted in your lease? Yes No
Please indicate weight limit, if applicable:
How is your yard secured?
No Fencing
Wood Privacy Fence - 6' high
Chain Link Fence
Wrought Iron Fence
Other
If other describe:
If you do not have a securely-fenced yard, how will you ENSURE that your dog does not escape?
Landlord's Name:
Landlord's Phone:
Landlord's Address:
Will you agree to allow us to visit your home by appointment as part of our application process?
Yes, I agree to allow you to visit
No, I do not agree to allow you to visit
If NO, please explain
Do you have a doggie door?
Yes
No
How many adults in your home including you? Please List All Of Them
Please list the children living with you (by ages)*:
Are they use to being around dogs?
Yes
No
Your Pets
List animals you currently own or that are in your care/house and those you have owned in the past five years, if you need more room list in comment box below (if you answer DECEASED and you don't answer the question about the circumstances of your pets death, your application WILL NOT be processed) :
Dog
Cat
Other
If Other, Please Explain what kind of Pet:
Name
Male
Female
Spay/Neuter
Yes
No
Housed
Inside
Outside
Both
How Long Owned?
Where is it now?
If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed)
If alive and not living with you, please give details about why you no longer have pet
Dog
Cat
Other
If Other, Please Explain what kind of Pet:
Name
Male
Female
Spay/Neuter
Yes
No
Housed
Inside
Outside
Both
How Long Owned?
Where is it now?
If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed)
If alive and not living with you, please give details about why you no longer have pet
Dog
Cat
Other
If Other, Please Explain what kind of Pet:
Name
Male
Female
Spay/Neuter
Yes
No
Housed
Inside
Outside
Both
How Long Owned?
Where is it now?
If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed)
If alive and not living with you, please give details about why you no longer have pet
Dog
Cat
Other
If Other, Please Explain what kind of Pet:
Name
Male
Female
Spay/Neuter
Yes
No
Housed
Inside
Outside
Both
How Long Owned?
Where is it now?
If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed)
If alive and not living with you, please give details about why you no longer have pet
If you have additional Pets, please describe in box at the end of this application - thank you.
Do your dogs have any physical problems? Yes No
If yes, explain
Do your dogs have any behavioral problems? Yes No If yes, explain
Do they get along with other dogs? Yes No
Do your dogs have any behavioral problems? Yes No If yes, explain
Veterinarian Information
Will you provide annual vaccinations and any necessary medical care?
Yes
No
Vet's Name:
Vet's Phone:
Vet's Address: We must have this reference to process your application.
Your New Dog Information
Check all that apply: You are looking for a dog as:
Playmate for current dog
Companion for self
Companion for family
Gift To fill the void of a beloved deceased pet Protection -
If protection, please explain:
Check all that apply: How will your new dog spend its days? :
Indoors
Crated
Basement
Garage
Porch Locked in room
Fenced yard
Loose unfenced Dog House
Kennel Run
Check all that apply: How will your dog spend its nights? : Indoors
Your bedroom
Kitchen Crated
Basement
Garage Porch
Locked in room
Fenced yard Loose unfenced
Tied outside
Dog House
Kennel Run
What would happen to this Dog if family situation changed (divorce, relocation, death)? Please answer this question in detail.
How many hrs. per day will dog be left alone (please explain)?
Who will be responsible for the care of pet (feeding and walking etc)?
Can you commit to this dog for its entire life?
Yes
No If NO, please explain
Who will be responsible for this Dog while you are on vacation?
Have you ever given away/sold or released an animal to a shelter or rescue group?
Yes
No If yes, why?
Have you ever been denied adoption by a shelter or other rescue or humane group?
Yes
No If so by whom?
Your References & Additional Info
Please give two references. These may be friends, co-workers and relatives. Please give name, relationship to you, email address and phone number.
Reference # 1
Reference # 2
Comment box for additional information:
Box for additional Pets information:
Closing Comments - Read Carefully
We will contact you as quickly as possible about your application.By signing below you are agreeing to ALL of Loving Touch's adoption terms and rules for adoption through us. This is a legal and binding contract and may be used as such in a court of law.
*Yes - I fully understand and agree to ALL the terms of this legal document. *No - I do not agree to ALL the terms of this legal document (your application will not be processed if you answer no to this question).
Signature*: