Canine Adoption Application
Dogs Change Lives
Please fill out this form completely if you are interested in adoption a dog/puppy from Lost Mittens Animal Rescue.  If your browser has problems with this form, send email and be sure to provide contact information.

You should receive a response to your application with in the next few days.   If you do not receive a response, please send email to the address which is posted at the bottom of each page on this site.
Canine(s) of Interest
You must be 18 years or older to complete this application.
Applicant Information
Home Environment
Reference Information
Care Information
Addition Comments
The undersigned applicant hereby grants Lost Mittens Animal Rescue permission to confirm any information provided in this application with any appropriate third party source, including landlords, veterinarians, etc. The information obtained will be held in confidence and used only by Lost Mittens Animal Rescue for purposes of this adoption application.


I certify that all the information on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected. I also understand that this adoption application is the sole property of Lost Mittens Animal Rescue.


It is specifically understood that the Lost Mittens Animal Rescue reserves the right to deny any adoption application at its own discretion.
Typing your name below will serve as legal signature.


By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue dog and possible removal of said dog from my home. Applicant must be 18 years of age or older. We reserve the right to refuse any applicant.
If you're interested in a particular puppy/dog(s) in our adoption program, please list the name(s):
Your Full Name:
Age:
Home Phone:
Work Phone:
Cell Phone:
What is the best time to contact you by phone?
Email Address:
(please enter carefully as we cannot respond to mistyped email addresses)
Address:
City:
State:
If applicable, please provide name and phone number of your Apartment Complex/Landlord:
Condo
Apartment
House
Do you live in a :
Mobile Home
Do you own or rent?
Rent
Own
If you rent, what is the policy?
How long have you been at this address?
How many people are in the household?
What are the ages?
Do you or anyone in your household suffer from pet allergies?
Yes
No
If yes, please explain:
Would you describe your home as:
Calm/Quiet
Some activity
Grand Central Station
Please list our previous/current pets:
For each pet, please indicate Name, Age, Type/Breed, if is was spayed or neutered, how long you owned it, whether you still own it.
Have your dog(s) been tested for Heartworms?
Yes
No
What was the test result?
Positive
Negative
Has a pet died while living in your care?
No
Yes
If yes please explain:
Have you ever turned in a pet to the animal shelter?
If yes please explain:
Would your new dog be living with or have any of these as frequent visitors?
Children Under 10
Teenagers
Other Dogs
Cats
Pet Birds
Pet rabbits/rodents
Other
Please provide the name and phone number of your primary veterinary clinic:
Do you collar and tag your pets?
Yes
No
What best describes the primary pet caregiver?
(check all that apply)
(check all that apply)
Retired
Stay at home parent
Employed full time
Employed part time
College student
Child/adolescent
How did you hear abou the Lost Mittens Animal Rescue?
Have you ever contacted the Lost Mittens Animal Rescue before?
Would you like to receive our email newsletter?
No
Yes
Where will the dog be kept?
Inside
Outside
Both
Will the dog be restricted to a certain area?
Yes
No
If yes, please describe
What kind of solution would you be willing to try if the dog acts inappropriately?
(check all that apply)
Other
Find new home for dog
Isolate dog to outdoors
Consult a trainer (dog school)
None
What kind of solution would you be willing to try if the dog develops problems urinating indoors?
(check all that apply)
Clean carefully and be patient
Use a dog door
Have dog examined by vet
Find a new home for the dog
Other
None
Would you still be able to care for this dog id your home or family situation changed (divorce, relacation)?
No
Yes
Who will decide what happens to your dog in the event you are no longer able to care for it?
Are you able to afford food and supplies (approx. $35 per month) and a yearly vet exam (approx. $100-200) for a dog?
No
Yes
The average lifespan of a dog is 10 - 15 years.  Are you prepared to make a lifelong commitment to a new pet?
No
Yes
Any Additional Comments
Thank you! You will be notified by Email
Driver's license #:
Date:
Signature:
No
Yes