items followed by * are required
Personal Information
Name*   
Address*   
City*   
State*   
Zip Code*   
Home Phone*   
Cellular   
Fax   
E-mail*   
 

 items followed by * are required
About Your Home
Do you own or rent your home?*    
If you rent, are dogs allowed on the property?  
Do you currently have a dog?*    
If you have dog(s), were they rescued dogs?  
If you have dog(s), how many do you own?    
Describe kinds of dogs owned   
Do you have other pets?    
Describe your other pets   
Number of adults in your home*    
Number of children*    
List ages of children   
Is anyone normally home during the day?*    
How long will the dog be left alone?*    
Where will dog stay during the day while left alone?*   
What kind of fence do you have?*    
If other, please describe kind of fence you have   
Where will the dog sleep?*   
Where will dog stay during extended absences (vacation, holiday, etc.)?*   
Who in family wants dog the most? *   
Have you ever surrendered or given up any pet you owned?*    
If you checked YES, what were the circumstances?   
Do you have a swimming pool?*  
If yes, is there an enclosure around the pool?
Willing to take dog to obedience classes, if needed?*  
Willing to crate for the first month when not home?*  
We believe it is safer to crate the dog in the house than to leave the dog alone in the backyard where it can dig out and escape or in the house where it can be destructive.
  
Please list main reason(s) for wanting to adopt a rescued Labrador Retriever*
  

 items followed by * are required
Please Provide The Following Veterinary Information
Do you have a veterinarian?*    

If yes, please indicate below the name, address and if known, the phone number of your veterinarian:
Name of Veterinarian
Address
City, State, Zip
Phone Number
  
  
 items followed by * are required
Your Preferences
Dog age preference*    
Dog gender preference*    
Dog color preference*    
Questions and comments    
Please indicate any special needs dog you might consider:  
Three legged Senior Dog Hip Problems Skin Problems
Blind Deaf Allergies Other Medical
If you checked any of the blocks above, please list any conditions or limitations
  
If you have any questions about the adoption process please list them
If any family member is opposed to adoption please list who and why