ALAC Rescue - http://www.lhasaapsorescue.org

AMERICAN LHASA APSO CLUB RESCUE
Adoption/Fostering Application
This questionnaire is designed to help you think through the various aspects of dog ownership that should be considered before you adopt a dog. We realize this is a long form, but Please answer ALL questions and elaborate as much as possible. Your answers give us a better idea of what you might consider the right dog for you. Again, PLEASE take the time to respond to EACH and EVERY question, incomplete applications will not be considered.

PLEASE DO NOT continue to fill out this application if you have children living with you, or visiting frequently, that are under the age of 12 years. Thank You!
Please use the TAB key to move from field to field.
Items marked with an * are required fields, this form will not process without them.
Some people have been having problems with the application, so you might want to as a precaution PRINT OUT A COPY OF THE APPLICATION, that way if there is a problem sending it you will have a printed copy you can fill out and snail mail to us. Make sure you have filled out ALL of the required fields, it will not send electronically if you haven't. If you are having a problem with the application, PLEASE CLICK HERE (opens in new window), print and fill out this application and email Amy or Helen to find out who to send it to.

First Name*:

Last Name*:

Email Address*:

Home Phone*:

Work Phone:

Cell Phone:

Street Address*:

City*:

State*:
[if Cananda state where in the comment box below]

Zip Code*:

Your Occupation*:

Your work hours*:

Your employer's name and phone number*:

Years employed there*:
If less than 2, previous employer name and phone number*:

I am applying to Lhasa Rescue Network for*
(no matter what you are applying for, we need a copy of Contract & Liability release mailed to us):

I am applying for Fostering, and I understand that I must also submit the Contract and Liability Release to help with Foster Care.
(Individuals who are applying as a foster home must fill in all forms and go through vet/reference checks and have a home visit conducted)
Yes No

You must also submit the Contract and Liability Release, this is a standard part of our application procedure.
If you chose D in the previous question, please specify what you are able and willing to do to help rescue.
I have special abilities that I believe can be of help to Rescue. They are:

Which of the following best describes your current residence?

If you rent, are pets permitted in your lease?
Yes No
Please indicate weight limit, if applicable:

How is your yard secured?
If other describe:

If you do not have a securely-fenced yard, how will you ENSURE that your dog does not escape?

Landlord's Name:

Landlord's Phone:

Landlord's Address:

Do you have a pool?
Yes, I have a pool - it is not fenced, though
Yes, I have a pool - with a security fence around it
No Pool

Do you have a doggie door? Yes No

How many adults in your home including you?
Please List All Of Them

Please list the children living with you (by ages):

If you do not have children now, are you considering starting a family in the future:

What is your age: Spouses age:
Please list the children visiting you, such as grandkids ( by ages):

Do you plan on moving in the next 6 months?
Yes No

Would your pet go with you if you moved?
Yes No

How did you hear about us?

List animals you currently own or that are in your care/house, and list ANY/ALL pets you have ever owned. (if you answer DECEASED and you don't answer the question about the circumstances of your pets death, your application WILL NOT be processed):

Dog Cat Other If Other, Please Explain what kind of Pet:	Name Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How Long Owned? Where is it now?	If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed) If alive and not living with you, please give details about why you no longer have pet
Dog Cat Other If Other, Please Explain what kind of Pet:	Name Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How Long Owned? Where is it now?	If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed) If alive and not living with you, please give details about why you no longer have pet
Dog Cat Other If Other, Please Explain what kind of Pet:	Name Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How Long Owned? Where is it now?	If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed) If alive and not living with you, please give details about why you no longer have pet
Dog Cat Other If Other, Please Explain what kind of Pet:	Name Male Female	Spay/Neuter Yes No	Housed Inside Outside Both	How Long Owned? Where is it now?	If deceased, please give details and circumstances leading to death (if you answered DECEASED and you don't answer this question your application WILL NOT be processed) If alive and not living with you, please give details about why you no longer have pet
If you have additional Pets, please describe in box at the end of this application - thank you.

Please specify which Lhasa Apso(s) on our website you might be interested in adopting, and the State they are in.

Please list any specific characteristics that you want to see in your new dog - lap dog vs. hyper, love sponge vs. independent, etc.

Who will be responsible for this Lhasa?

How many hours a day will this Lhasa be alone?
Where will it be kept at night?

Where will the dog stay during the day?

Is anyone in the household allergic?
Yes No

Would you adopt a special needs dog/puppy? (ie. blind, timid, 3 legged, daily medication)
Yes No

Why are you interested in getting a Lhasa at this time?
All of these dogs need a refresher course in housebreaking. How will you housebreak your dog?
Do you understand that dogs bite out of fear and distrust? Unfortunately, they do not have hands to slap the face of that obnoxious stranger that is grabbing and touching them. The only way they have to protect themselves is with their teeth.

Although we do not take people-aggressive dogs into our program, we do accept abused and un-socialized dogs. These dogs often need work with temperament problems. How will you deal with behavior problems like snapping or biting? Any dog that has ANY known history of snapping will NOT be adopted to a family with children. But, understand that a dog may react to your environment differently and you must be prepared to deal with it.
What would happen if your dog got very sick and you were looking at spending thousands of dollars to cure the illness?

Who will be responsible for this Lhasa while you are on vacation?

Do you plan to walk your Lhasa Apso at least 2 times per day?
yes no

Do you have a disability that would keep you from walking your Lhasa?
yes no

Have you ever given up a pet in the past?
yes no
If so what were the reasons:

What would make you consider giving up your Lhasa: (check all that apply)
Accidents in the house
Problems with another pet
Moving
Divorce
New baby (afraid dog might bite)
Aggression toward anyone
Other (specify in notes at end)

What would happen to this Lhasa if family situation changed (divorce, relocation, death)?
Please answer this question in detail.

Have you ever given away/sold or released an animal to a shelter or rescue group? Yes No

If yes, why?

Have you ever been denied adoption by a shelter or other rescue or humane group? Yes No

If so by whom?

Will you provide annual vaccinations and any necessary medical care? Yes No

Vet's Name:
Vet's Phone:

Vet's Address:
We must have this reference to process your application. If you are a first time pet owner, please annotate.

Please give three additional references. These may be friends, co-workers and relatives. Please give name, relationship to you, email address and phone number.

Reference # 1
Reference # 2
Reference # 3

Comment box for additional pertinent information:

Box for additional Pets information:

Read Carefully: Do you understand that it may cost as much as $1200 a year for grooming, routine veterinary visits, high quality food and supplements and non-routine veterinary visits. So please if you have any questions or concerns, email us. We want to make sure that our dogs and families are the best possible match for each other.

We will contact you as quickly as possible about your application. Please consider that all of us are volunteers and have other jobs & responsibilities besides rescue work...we appreciate it if you remember this at all times during the application process. We get hundreds of emails and phone calls in a week regarding rescue, and work as hard as we can to respond as soon as we can.

By signing below you are agreeing to ALL of ALAC Rescue's adoption terms and rules for adoption through us. This is a legal and binding contract and may be used as such in a court of law.

YOU MUST HAVE FILLED OUT, SIGNED AND PRINTED COPIES OF our CONTRACT (opens in a new window) &
LIABILITY Forms (opens in a new window). We will contact you as quickly as possible about your application.

You must check one:
Yes signifies that - I have located and read the Mission Statement/Volunteer Promise and the Policies and Guidelines of ALAC Rescue on the website. As an adopter - I understand and agree with your policies. As a Volunteer - I understand and agree to abide by all the stated policies and guidelines and to work to uphold the Mission Statement (I understand this is printed right on my copy of the application and is a legal binding agreement in a court of law).
OR
No signifies that - I have not located and read the Mission Statement/Volunteer Promise and the Policies and Guidelines of ALAC Rescue on the website (answering no voids your application for adoption/volunteering).
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Signature*:

Date*:

After you click Submit Form (only once please), you will be taken to a copy of your form, please check it to be sure it's OK, if not email us with the correct info. If you would like a copy for yourself, print it out from this page. Thanks :)

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