Personal Information

Dog's Info

Provide the name of the dog

Provide the dog's adoption number

About You

Provide your full name

Must be over 18

Are you employed?

Select yes if you are employed


Provide your phone number

Provide your e-mail address

Can we call you at work? (optional)


Provide your street address

Which city do you live in?

Provide your postal code



Select your house type?

Rent or own?

Do you rent or own?

Rural or urban?

Do you live in a rural or urban area?

What is your yard size?

Is your yard fenced?

Is your yard fenced?

Pet Preference


What size of dog do you prefer? (optional)

Tell us why you want to adopt

Select todays date


I certify that all the information provided is correct and true with nothing of relevence being omitted. I realize that my application may be denied if I have provied false or misleading information.

I grant my permission for Loyal Rescue to contact my references and vet.

I am aware the home visits are mandatory prior to and after adoption on a random basis.

I am financially and physically able to care for a dog.

Please agree to the terms