Dog Adoption Application

All fields are required. You may put N/A if the question does not apply to you.

Name*

First Last

Date of birth*

Email*

Main Phone*

Alternate Phone

Address*

Street Address Address Line 2 City State ZIP Code

Occupation*

Employer*

Work Hours*

List all adults and children living in your home. Total number, yourself included*

Name	Age	Occupation	Relationship	Phone Number

Is anyone allergic to dogs?*

Yes
No

Does everyone agree on adopting the dog?*

Yes
No

Do you rent or own your home?*

Rent
Own

If rent, may we contact your landlord?*

Yes
No

Landlord Name*

First Last

Landlord Phone*

Type*

House
Apartment
Townhouse
Condo
Mobile
Other

If other, describe*

If you have a yard, describe the size & fence type/height*

Is there a lock on the gate?*

Yes
No
N/A

Do you have a dog door?*

Yes
No

Do you have a pool?*

Yes
No

Is it securely fenced?*

Yes
No

Is there a balcony?*

Yes
No

Is it enclosed?*

Yes
No

Is this your first dog?*

Yes
No

Reason for adopting*

Can you commit to the care and veterinary costs for the life of the dog (up to 10-15 years)?*

Yes
No

How much would you spend if your dog was ill or needed surgery?*

Veterinarian Name*

Veterinarian Phone*

How did you hear about Lange Foundation?*

List 2 personal references who do not live in your household:*

Person 1: Name	Phone	Relationship

How many hours a day will your dog be alone?*

When you go out of town, do you have a plan in place for your pet(s)?*

Yes
No

What training method do you plan to use?*

Do you currently have any pets?*

Yes
No

Please list your pets current ages and breeds:*

Where are your pets from?*

Are your pets spayed/neutered?*

Yes
No

Are they current on vaccines?*

Yes
No

Do your pets have any medical or behavioral issues? Please explain:*

Have you ever rehomed a pet?*

Yes
No

Why?*

Under what circumstance would you consider rehoming your pet?*

If you can no longer care for your pet, do you have someone who has agreed to assume ownership?*

Yes
No

If yes, who?*

First Last

Phone*

Name of dog(s) interested in*

Describe in detail your ideal dog (breed, age, gender, temperament, activity level, etc)*

Under what circumstances would you crop a dog’s ears or dock the tail?*

Where will your new dog spend the day? (check all that apply)*

Where will your new dog spend the night? (check all that apply)*

If "Other", describe*

What location(s) are you open to visiting?*

West LA Kennel
St. Bonnie’s Sanctuary (Canyon Country)
Both

How soon are you ready to bring home your new pet?*

Sterilization: If the dog I want to adopt is not yet sterilized, I agree it must be sterilized either before or shortly after I adopt it and agree to deliver proof of same to Lange Foundation.

Home visit: I agree to allow a Lange Foundation representative to visit my home as part of the application process.

Applicant information: I have filled out this application completely and all of the information provided is true and correct. If any of the information changes, I will promptly update Lange Foundation.

Completion of application does not guarantee adoption: Lange Foundation has the right to deny any application.

Date*

Signature*

Dog Adoption

Halfway Home Kennel

St. Bonnie’s Sanctuary

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