Quad City Lab Rescue, Davenport, IA
On Line Adoption Form:
First Name:
Last Name:
Co-applicant name:
Relationship to applicant (i.e. parent, spouse, room-mate etc):
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Work Phone:
Email:
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What type of residence do you live in:
Apartment
House
Condo
How long have you lived at present address?
Years
Do you own or rent?
Own
Rent
If you rent, please supply the name, address and phone number of your Landlord
How many people live in the household:
Adults:
Children:
List the ages of all children:
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Do you have a fenced yard?
Yes
No
Height of fence:
Feet / Type of fence:
If not completely fenced or no fence how will you keep your dog on your property?
How long will dog be left on his/her own during an average day?
Hours
Where will dog be kept during day whilst you are out?
Where will dog be kept during the night?
If you move in the future what are your plans for your dog?
If you have to travel away from home (vacation, business etc) what will you arrange for your dog?
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Have you owned a dog before?
Yes
No
If yes what breed type and what happened to him/her/them?
Do you currently have any dogs? If yes, please list below
Yes
No
Dog 1
Breed:
Age:
Sex:
Male
Female
Spayed/Neutered:
Yes
No
Dog 2
Breed:
Age:
Sex:
Male
Female
Spayed/Neutered:
Yes
No
Dog 3
Breed:
Age:
Sex:
Male
Female
Spayed/Neutered:
Yes
No
Dog 4
Breed:
Age:
Sex:
Male
Female
Spayed/Neutered:
Yes
No
Do you currently have cats or other small animals?
Yes
No
Name, address and phone number of current (or if presently have no pets name last one used) veterinarian:
Have you applied now or in the past to any other breed rescue groups or shelters, and if so which ones and what was the result?
Is there a particular dog on the website you are interested in, and if so, why.
Tell us briefly about your lifestyle (this will help us match the best dog to you)
Briefly explain why you are wanting a dog:
Any extra comments you feel are relevant: