Dog Adoption Online Form Step 1 of 2 50% GREETINGS! Thank you for your interest in adopting a dog with LCAL. Please note that not every pet will fit into your lifestyle. Our adoption counselors will ask you many questions to determine which dog will do well in your home and which will not. This way we can be sure the dog you get will be the pet you want -- to love for its lifetime! Please understand that we deal with homeless or unwanted animals. Many of our animals come from unknown backgrounds through the local shelters: most have medical or behavioral concerns that we have addressed as well as providing their well care. We were truly their last chance. The adoption process may seem time consuming, but we wish to maximize an animal's chance for a successful, permanent adoption. Adopting a companion pet is a major consideration, and responsible dog ownership demands a considerable commitment. All we ask in return is that you love and care for this dog for its lifetime and make a donation that will allow us to help the next animal in need. Thank you for your interest in our adoptable animals.Dog name(s) you are interested in adopting*Your Contact InformationName* First Last Occupation*Home Phone*Cell PhoneWork PhoneEmail* How did you hear about Last Chance at Life?Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you resided at this address?*3 years or moreLess than 3 yearsLess than 2 yearsLess than 1 yearPlease list your previous address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you own or rent your current residence?*OwnRent NOTE: If you rent, a written confirmation that you can have a dog (indicate weight limit/breed restrictions) from the landlord, with address, and phone number is required. Please call your landlord and have it faxed to (760)433-3138 or e-mailed to Info@LastChanceAtLife.orgYour Home & FamilyAre there children where the pet will be living?*YesNoIf yes, what are their ages?*Would you consent to a pre-adoption and post-adoption home visit?*YesNoIf no, why not?*Current & Previous PetsWhat pets have you owned before (birds, dogs, cats, etc)?*Did you have them Spayed/Neutered?*YesNoN/AIf no, are you willing to do this?*YesNoWhere are they now?*Still with usDeceasedOtherIf they are still in the home, how are they with other animals?*Do you have a current veterinary hospital?*YesNoIf you are not a client at Mission Animal and Bird Hospital, a letter of recommendation from your regular veterinarian will be required for the adoption application to be completed. Please call and have it faxed or emailed to 760-433-3138 or email@example.com.Name of veterinary hospital*Phone number of veterinary hospital*How your dog will live with youA typical day for your dog will consist of how many hours inside, outside, crate etc.Inside hours*Will this time be supervised or alone?*SupervisedAloneOutside hours*Will this time be supervised or alone?*SupervisedAloneCrate hours*Will this time be supervised or alone?*SupervisedAloneDescribe any other time throughout a typical day of your dogHave you ever used a crate to train a dog?*YesNoAny objection to doing so if needed?*i.e. to prevent unwanted behavior [chewing electric cords, furniture, house trainingIs your yard fenced “dog secure”?*YesNoIf not, how will you "potty" your dog?*Will outside shelter be needed/available while you are away?*YesNoHave you trained a dog in basic obedience in the past?*YesNoAre you willing to attend obedience classes for formal training?*YesNoWhat type, breed, age, size, and animal interests you?*Are you financially prepared to provide the necessary care for your dog?*YesNoThis includes proper food, vaccinations, parasite control (heartworms, fleas, ticks, intestinal parasites, etc.), licensing, adequate shelter, and veterinary care for yearly check-ups, or an after-hours medical emergency or illness, which could cost $500 or more.Are you willing to COMMIT yourself and your energies to this dog for its lifetime?*YesNo I affirm that all application information is true. I realize that this is a lifetime commitment to this animal and I will endeavor to give this pet a happy and healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTER FOR ASSISTANCE, OR IF I EVER MUST GIVE IT UP I WILL RETURN IT TO MY ADOPTER.Acknowledge with your initials*FOLLOW-UP AGREEMENT: I agree to allow Last Chance At Life All Breed Rescue to do a home visit prior to adoption, and as a follow-up, if needed, to ensure the premises where the animal is kept meets the terms of the adoption agreement and to reclaim the animal, if in the judgment Last Chance at Life All Breed Rescue, the animal is not being adequately cared for, the terms and conditions of this adoption contract have not been met, or if I have misrepresented any facts to Last Chance At Life All Breed Rescue, Inc. during the adoption process.Acknowledge with your initials*NO WARRANTY OR GUARANTEE: I understand that every effort is made to offer for adoption of only healthy, even-tempered animals. However, animals are only available for observation by Last Chance at Life All Breed Rescue for a short time, and therefore, neither guarantees, nor implied / expressed warranties with regard to this animal are made. I understand and agree that it is my responsibility to carefully choose the animal I am adopting and that no guarantees are made regarding the health, temperament, or training of animals for adoption. I understand and agree that LCAL, All Breed Rescue shall not be liable, in whole or in part, for any personal injury or property damage caused by this animal, or for any injury or illness of this animal, once possession is assumed by the Adopter. The Adopter, hereby, agrees to assume all liability for the animal’s care and any injury or damage done by the animal.Acknowledge with your initials*Last Chance at Life All Breed Rescue will provide me with a current medical record showing history of this pet's medical conditions that are known at the time as well as all recommended procedures and the time line for their completion.Acknowledge with your initials*By signing below, I swear that I have read and understand the terms of this adoption contract, and all of my obligations and responsibilities pertaining to adopting this animal. I enter into this contract of my own free will and agree to all the terms and conditions contained herein. Signature*NOTE: Your donation has helped to save one or more animals from demise. However, the cost of veterinary services, medications, vaccinations, spay/neuter, care, etc, often exceeds the donations asked. If you would like to increase the donation, in order that we may save more animals, please help others by adding to your gift.Intended Donation*PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.