Life Saver Animal Rescue

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Pet Name or breed:
Applicant Name:
Street Address:
Zip Code
Best Telephone Number
Email Address
Confirmation email will be sent to this address.
Current Veterinarian & Telephone Number
I wish to Adopt a Dog Because:
Personal References (Please List Two--Names, Addresses, Phone):
About You and Your Household--Please Check Appropriate Box (x):
**Are You: Working, Homemaker, Retired, Attending School, Other:
Bus. Phone:
**Type of Housing: Home, Condo, Apartment, Mobile Home, RV
Own, Rent, Live With Parents, Rent Lot Space, Other:
If you are renting your home, Please enter the Landlord's Name name and telephone here.
Other individuals in household
**My Experience with Dogs: First Time, Had One or Two, Very Experienced
**Do You Have Other Pets Now? Yes, No, If Yes: Cat, Dog
If you do have other pets now,
 How Many Cats:  How Many Dogs:
Name: Age  Breed 
Name  Age  Breed 
Name  Age  Breed 
Name  Age  Breed 
Where Did You Get Pet?
Length of Time You Have Had Pet Years 
Spayed/Neutered? Yes No
**If You Don't Have a Pet Now, Have You Ever Had a Pet Before? Yes, No
If Yes: Cat, Dog
Spayed/Neutered? Yes, No
Length of Time You Had Pet Years 
What Happened To Pet
**Have You Ever Adopted a Pet from LSAR Yes, No
Your Preferences:
**Size of Dog I'd Like: Small (up to 20 lbs) Med. (20-50 lbs)
Large (50-100 lbs)
Giant (over 100 lbs). Prefer: Male, Female, Either
**I'd Like these Personality/Temperament Traits in My Dog: Quiet,
Mellow, Affectionate
Lap Dog, Protective, Vocal, Herder, Retriever,
Loves Water, Other:
**Training Preferences: None, Some Obedience, Housetrained,
Fully Trained
**For Exercise I Prefer a Dog that: Walks on a Leash,
Walks on & off Leash, Will Run or Hike with me
Will Exercise Itself, Requires No Exercise
**I Prefer a Dog with an Energy Level that is: High, Moderate, Low
**I Presently have: A Fenced Yard, An Enclosed Kennel, A Stationary Tie-up,
My Dog would be (where) during the day
My Dog would be (where) during the night