Adoption Application This form and a consultation with a our representative are designed to help you find the dog most compatible with your lifestyle. Completion of this application does not guarantee adoption of a dog. Please respond to the questions below as completely as possible. In order to be considered as an adopter you must: 1. Be 21 years of age or older 2. Have a valid driver's license or other government-issued ID 3. Have proof of the knowledge and consent of your landlord if renting 4. Be willing and able to provide proper care, training, and medical treatment. This organization works on volunteering and all volunteers also have a full-time job. Please be patient as we review your application or while waiting for a response to your questions. We will be in contact with you as soon as possible. DOWNLOAD ADOPTION AGREEMENT *Name *Email *Address *Street Address Address line 2 *City *State *Postal / Zip Code *Country United StatesUnited KingdomAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkinaFasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKoreaKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, the former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuela, Bolivarian Republic ofViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe *Cell Phone *Alternate Phone *Who are you interested in adopting? *Occupation *Employer *Employer Address *Number of Adults in Household and Ages *Number of Children in Household and Ages *Who will be the primary caregiver for your new dog? *Are all the adults in your household aware that you are adopting a dog and in agreement? YesNo Is any member of the household allergic to dogs? YesNo *What type of housing do you live in? HouseApartmentCondoOther *Do you own or rent? OwnRent *Landlord's name and phone number *Do you have a completely fenced in yard? YesNo *If yes, please specify fence type, height, and gate/no gate. If no, how do you plan on walking your dog? *Why do you want a dog? *What qualities are you looking for in your new dog? *Which of the following behaviors would be a serious problem for you? excessive barkingdiggingjumping a fencenot getting along with catsnot getting along with other dogsnot good with childrennot housetrainedtoo activenot playful with other animalsnot playful with childrennot good being left alonedifficult to walk on a leashtoo bigtoo much sheddingOther *If "other" please specify: *How many hours each day will the dog be left alone? Where will the dog be kept when alone? If you plan to crate, how many hours will the dog be in the crate? *Where will the dog be when you are home? Where will the dog sleep at night? *Are there times when the dog will be tied outside? If yes, when? *How often and what type of exercise will you give your dog? *Is this your first dog? YesNo *If you presently have a companion animal(s), please specify their name(s), breed(s), age(s), gender(s), spayed/neutered (yes or no), current vaccines (yes or no) *If you previously had a companion animal(s), please indicate name(s), breed(s), years owned, and what happened *Name and location of veterinarian: *Have you ever given a pet to the shelter? YesNo if yes, please explain *Are you planning to attend obedience classes with your new dog? YesNo *If your new dog is not housebroken, how will you correct him/her when there is an accident, and what method will you use to train? *How long do you expect housetraining to take? *When you go on vacation/travel, who will care for the dog? *How much are you willing to spend on medical bills for your dog? *What would you do if the bills go over this amount? *Are you ready to take responsibility for this dog/puppy for the next 10-15 years? YesNo *What provisions will you make for the dog should you become unable to care for him/her? *Please list two references including their phone numbers and relation to you *Are you willing to have a representative of visit where the dog will be living? YesNo I certify that the information above is true and that false information will result in nullification of this application YesNo IF ACCEPTED AS AN ADOPTER BY SIGNING THIS DOCUMENT, I ACCEPT IT AS A BINDING CONTRACT AND UNDERSTAND AND AGREE TO THE FOLLOWING Any dog adopted from Legacy Rescue is to be an indoor dog and treated as a member of your family. Any dog adopted from Legacy Rescue shall be afforded all necessary vaccinations, licenses, heartworm and flea prevention, plus any medical treatment that may become necessary. If for any reason you can no longer care for your adopted dog, it must be returned to Legacy Rescue. Legacy Rescue retains the right to remove a dog adopted from us that has been deemed abused, neglected, or found to be in a situation that may not be in the best interest of the dog. I hereby give permission for my Veterinarian to release information to GDR on any pets that I have owned, live or deceased. Legacy Rescue reserves the right to refuse a dog to any applicant. Any misrepresentation of fact may result in my not being approved to adopt a dog from Legacy Rescue. All information I have given on this form is true and correct.