| Full Name: * |
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| E-mail Address: * |
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| Phone Number: * |
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| Home Address: * |
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| City: * |
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| State: * |
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| Zip Code: * |
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| Date of Birth: * |
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| Occupation: * |
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| Married/Single: * |
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| Children? Ages?: * |
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| Anyone else that lives in the same household? Names and ages: * |
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| Does anyone have allergies or asthma that would be aggravated by a dog?: * |
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| Have you ever owned a dog before? What kind?: * |
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| What happened to your previous pet(s): * |
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| Are there any other pets? Species, Breed, Age, Gender: * |
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| Are/were any of your pet(s) spayed or neutered?: * |
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| Are/were any of your pets current on their vaccinations?: * |
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| Name and phone number of your past or present Veterinarian: * |
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| Do you own or rent?: * |
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| Have you discussed adopting a pet with your landlord and been approved to have a pet?: * |
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| Where will the dog(s) stay during the day and at night?: * |
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| Have you discussed adopting a pet with your family and is everyone in agreement about adopting?: * |
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| If you travel much, what do you plan on doing with your dog while you are away?: * |
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| Will the dog be with someone durring the day?: * |
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| Do you have a fenced in back yard? If so, what kind of fence is it? How high is it?: * |
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| Would you take your dog through a basic obedience course if needed?: * |
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| Have you ever been convicted of animal abuse or animal cruelty?: * |
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| Would you be OK with LBL Animal Rescue doing a background check to make sure that all of the information listed above is correct?: * |
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| Name of dog(s) you are interested in?: * |
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| Signature and Permission: By entering your name in this box, you are giving LBL Animal Rescue permission to call the Veterinarian you have listed above to obtain medical history about your previous pets.: * |
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| Date: * |
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