Liberty Humane Society - Dog Application

Liberty Humane Society
235 Jersey City Blvd., Jersey City, NJ 07305
Telephone: 201-547-4147 Fax: 201-547-8381
Email: lhs@libertyhumane.org
www.libertyhumane.org

The mission of our trained adoption counselors is to find the best pet for your family and to place animals into life long loving homes. If we do not have the perfect dog for you, we will keep your application on file.

* Date

* Name

* Address

* City

* State, ZIP

* Primary Phone

Secondary Phone

* email address

* Would you like to be on our mailing list?

Yes

No

If this application is for a specific dog, please enter the name here:

* Why do you want to bring a new pet into your home?

* What type/breed of dog are you looking for?

* Do you prefer male or female? Why?

* Maximum size when full grown?

* Up to what age are you willing to adopt?

* Do you live with

Spouse/Partner

Family

Roommate(s)

Alone

If no children live with you, do children visit on a regular basis?

Ages of children in the household

* Is everyone in your household in agreement on adopting a pet?

Yes

No

* Is anyone in your household allergic to animals?

Yes

No

* Do you own your home?

Yes

No

If you rent, please provide us with your landlord’s name and phone number so we can verify you are permitted to have pets

* Do you live in a

House

Apartment

Other

* What setting?

Urban

Suburban

Rural

* Are you planning to change residence in the near future?

Yes

No

* What will the dog’s living situation be?

Dog will be a house pet and live inside with family

Dog will live (primarily) in basement or garage

Dog will live (primarily) outside

Will be guard dog for business or residence

Other. Please explain:

* On average, how many hours a day will the dog be home alone?

* When home alone, the dog will be:

* Are you looking to adopt a dog (check all that apply)...

For yourself?

As a companion for a current pet?

As a companion for your child(ren)?

As a gift?

* What types of activities are you hoping to do with the dog (check all that apply)?

* Do you prefer a dog that is (check all that apply)

* You do not want a dog that (check all that apply)

* Do you have other pets at home? Please specify breed, age, spayed/neutered

* Do you have experience training a dog?

Yes

No

Please explain methods that have worked for you in the past

How did you learn your training techniques?

Self-taught

Friends/Family

Professional trainer. Name:

* Do you have experience with the breed of dog you are interested in? Please explain:

* If you’ve had other pets in the past, please elaborate:

Please provide the name and phone number of your veterinarian

Please provide names and phone numbers of two references (neighbors, friends, etc.). Relatives may not be used as references.

* Reference #1: Name

* Relationship to Applicant

* City, State

* phone number

email address

Reference #2: Name, Relationship to Applicant, City, State, contact information

By signing below, I certify that the information I have provided on this form is true, correct, and accurate.
I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the applicant(s) and Liberty Humane Society

* Signature: By typing my name in the field, I am confirming that all information that I have provided is accurate.

* Indicates Response Required


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