Basic Form

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Personal Information

Dog's Info

Dog's name

Provide the name of the dog

Adoption number

Provide the dog's adoption number

About You

Full name

Provide your full name

Age

Must be over 18

Are you employed? Yes No

Select yes if you are employed

If yes, your job title (optional)

Contact

Primary phone

Provide your phone number

E-mail address

Provide your e-mail address

Work phone (optional)

Can we call you at work? (optional) Yes No

Address

Apartment number (optional)

Street address

Provide your street address

Province

City

Which city do you live in?

Postal code

Provide your postal code

Lifestyle

Environment

Type of house

Select your house type?

Rent or own? Rent Own

Do you rent or own?

Rural or urban? Rural Urban

Do you live in a rural or urban area?

Square footage (optional)

Yard size

What is your yard size?

Is your yard fenced? Yes No

Is your yard fenced?

Pet Preference

Preference

What size of dog do you prefer? (optional) Toy Small Medium Large

Why do you want to adopt a dog?

Tell us why you want to adopt

Date

Select todays date

Agreement

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.

I agree to the above statements and am older than 18

Please agree to the terms