DOG APPLICATION

 
We ONLY place our animals in-state within 60 miles of Chicago.

If you do not live in one of these areas, please do not fill out an application.  We DO NOT allow our animals to be shipped.

* indicates a required field, although we also ask that the application be filled out entirely.

We are not affiliated with any organizations on the East Coast using the name New Leash On Life.

Name of Dog:

Please provide the following contact information:

* Name
* Street address
Address (cont.)
* City
* State (Chicago area residents only)
* Zip/Postal code
* Home Phone
Work Phone
Cell or Pager
* E-mail
Age: Under 21
21-24
25-29
30-39
40-49
50-59
60+
Your occupation:
Work hours:
Number of persons in household:         
Number of children:
Ages of children:
Name of spouse or roommate:
Occupation of Spouse or Roommate:
How long at present address? (specify years or months)
Do you rent or own?
Landlord's Name
Landlord's Phone No.
Type of residence:
Type of fence:   If other:
Height of fence:
Type of gate:   If other:
Number of gates:
Height of gate:
Type of lock:
Who, other than members of your household, has access to your yard when you are not home?
Do you have a swimming pool? Yes
No
If yes, do you know how to introduce your dog to it?
Is swimming pool surrounded by a gate?
Yes
No
N/A
When would the dog be inside?
If other, please specify:
When would the dog be outside?
If other, please specify:
In what areas would the dog be allowed?
What rooms are off limits to the dog?
What outside areas would be available to the dog?
Fenced Yard
Balcony
Kennel/Run
Covered Patio
Other
How many hours of the day would the dog be alone?
Do you have a pet door? Yes
No
Where would the dog sleep at night?
Who is the pet for?
If other, please specify:
Who will be responsible for taking care of the dog?
Is anyone in your household allergic to dogs?
Yes
No
What is your preferred level of exercise with the dog? (choose all that apply)
Couch Potato
Yard Exercise
Short Walks
Vigorous Walks
Hiking/Jogging
Dog Parks
How do you plan to provide for the dog when you are out of town?
What would you do if you had to move and had trouble finding a place that allowed pets?
What would happen to the dog if you had to relocate out of state or overseas?
Do you have any experience with dog training?
Yes
No
If yes, what experience?
Would you be willing to attend obedience classes at your own expense?
Yes
No
How will you discipline the dog if it misbehaves?
What would you do if the undesirable behavior continued?
Under what circumstances would you not keep the dog?
What would you do in that event?
Are you willing to live with an animal that be destructive at times?
Yes
No
How would you rate your dog experience?
1st Time Owner
Beginner
Intermediate
Advanced
Other:
How do you normally walk your dog?
On Leash
Off Leash
Which of the following reasons might prompt you to give up your pet?
Excessive Barking
Digging
Moving
Poor Watchdog
Destructive Chewing
Allergies
Growling at Guests
Aggressive with other Dogs
New Spouse/Partner doesn't like dog
None of the above
 Biting
Jumping on People
Divorce
Shedding
Financial Problems
Accidents Indoors
Excessive Vet Bills
Aggressive with Cats
Dog's Health Problems (hip dysplasia, overactive thyroid, heart murmur, etc.)
Are you prepared for veterinary expenses such as emergency medical problems (especially in old age), that you will incur when adopting this dog for its entire life?
Yes
No
Existing and Previous Pet Ownership Information:
Please indicate all dogs and cats you have owned, and all pets you currently have.  Under the column "What Happened" explain if the pet was lost, given away, stolen, sold, taken to an animal shelter, or died (in which case state cause of death).
Type of Pet:

Sex:  Female   Male   

Name:
Breed(s):
How & Why Obtained: 
How Long Owned: (specify years or months)   
Current age or age at death:
What Happened? 
 
Type of Pet

Sex:  Female   Male
Name:
Breed(s):
How & Why Obtained: 
How Long Owned: (specify years or months)   
Current age or age at death:
What Happened?
 
Type of Pet 

Sex:  Female   Male
Name:
Breed(s):
How & Why Obtained: 
How Long Owned: (specify years or months)    
Current age or age at death:
What Happened?
Have you ever bred a dog? Yes
No
If yes, why?
If you presently own a dog or cat, is it spayed or neutered?
Yes
No
If not, please explain why:
If you have cats, are they indoor or outdoor?
Indoor only
Outdoor only
Indoor/Outdoor
Do you have a veterinarian? Yes
No
Name and City of vet:
Would you agree to an inspection of your premises by New Leash On Life?
Yes
No
Why do you want this dog?
Is there any other pertinent information you would like us to know?
 
Please provide a personal reference (not a relative) below.
Name:
Phone:
How did you hear about NLOL? (Please select all that apply.)
Friend/family member
Adoption Event
Pet supply store
Veterinarian
Petfinder.org
1-800-Save-A-Pet.com
Internet Search Engine
Print publication (Chicago Reader, TimeOut Chicago, Chicago Free Press, etc.)
 Other:

* Please note that a home visit is required prior to final placement.
A home visit does not guarantee placement.

© 2007 New Leash On Life