Please note: You will receive a confirming e-mail upon successful receipt of your application within 24 hours. If you do not receive this confirmation, please re-apply. APPLICANT'S INFORMATION Full Name Street Address City State Zip Code Telephone Number E-mail Address Driver License # Date of Birth Employer How Long? Work Telephone Number Occupation Can you be contacted at work? Yes No HOUSEHOLD INFORMATION Which of the following best describes your current residence? House Condo/Apartment Mobile Home Student Housing Military Housing Not Applicable Urban Suburban Rural Rent Own If you rent, Landlord's: Name Telephone Number How long have you lived at your present address? Do you have any objections to a Home Check or Visit? Yes No Are you planning to move within the next year? Yes No If yes, what are your plans for your companion animal when you move? How many adults live in your home? How many children live in your home? Please list children's ages. Are all members of your household aware of your plans to adopt? Yes No Are any members of your household allergic to animals? Yes No Where will your companion animal sleep? House Garage Outside Crate in House Dog House Outside Do you have a fenced yard? Yes No If not, will you fence an area for the animal? Yes No How many hours per day will your companion animal be alone? Who will be responsible for the animal? VACATION How often do you go on vacation? Where will your companion animal stay? Kennel Name of Boarding Kennel Phone Family Name of Family Member Phone Friend Name of Friend Phone OTHER ANIMALS List all companion animals you have had in the past 4 years, including current: Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal? Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal? Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal? Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal? Name Type Dog Cat Kept in the House in the Garage Outside Dog House Outside Other Age Sex Male Female Neutered Male Spayed Female Still Own?Y N If no, what happened to the animal? Name of Veterinarian Telephone Number Address REFERENCES Name Telephone Relationship Name Telephone Relationship Name Telephone Relationship QUESTIONS Why do you want to adopt an animal? Which animal are you interested in adopting? What type of personality are you looking for? (If applicable) Have you ever had a special needs animal before? YN If yes, describe. If necessary, how will you discipline the animal? Please provide any additional information or comments in the box below. Lobo makes no guarantees on Genetic health problems as all animals were rescues and background of health is unknown. We do agree to guarantee that if the animal does not adjust to your home we will take back the animal and replace it with another animal. We also agree to give all medical information on the care given to the animal while with us. Our animals are temperament tested & crate trained. Deposits and adoption fees are Non-Refundable. Cash, cashier's check or money Orders accepted only. By submitting this form, I certify that all information supplied by me on this application is true, and I understand the conditions of Adoption. I will agree to a home visit/check; and Lobo Animal Rescue Shelter has the right to reclaim my animal if these conditions are not met.