Luna's House Adoption Application

Luna's House, Inc. Dog Adoption Application
It is the responsibility of Luna’s House, Inc. to place each dog we serve in a home compatible with his or her needs to ensure the adoption is in the best interest of both the dog and the adopter. You MUST fill out this application completely. Partially filled out applications will NOT be accepted If for some reason you have technical problems with this form, please let us know. PLEASE ANSWER ALL QUESTIONS CAREFULLY AND COMPLETELY.
Name(s) of dog(s) for whom you are applying:
Please list your Full name (First, Middle Initial, Last).
Please list the Full name (First, Middle Initial, Last) of any other adults in your household.
Are you at least 21 years of age? Please note that we can only accept applications from individuals who are at least 21 years of age	Yes No
Please enter your date of birth.
Address:
City, State and ZIP:
Telephone:
Email address (PLEASE BE ACCURATE, this is how we will contact you):
What type of home do you have?
Do you (select all that apply)	Own Rent living w/roommates Rent living alone Living with Parents Student Other
If renting, Landlord's Name and Phone
How long have you been at your current address?
If at current address for less than one year please provide previous address:
Do you live on a military base?	Yes No
Do you have a swimming pool?	Yes No
If yes, how do you plan on keeping the dog safe in the vicinity of the pool?
Is your yard fenced?	Yes No
If yes, what type and height of fence? (We do not require a fenced yard for the majority of our dogs.)
Why do you want to adopt a dog?
Please list any preferences (age, sex, breed, personality, etc.)
Do you currently have an application in to adopt an animal through any other organization?	Yes No
Have you ever had an application declined for adoption of an animal?	Yes No
If yes, please explain.
For whom are you adopting a dog?	Self A gift For another family member
How many children are in your home? Please list the ages of any children.
Has everyone in the home visited the dog?	Yes No
Does everyone in the home agree with the adoption?	Yes No
Does any member of your household have any known allergies to dogs?	Yes No
If yes, please describe:
Who will have the primary responsibility for this dog’s daily care? (Feeding, Cleaning, Exercise, Socialization, Medical, Attention, Love)
It is unrealistic to expect a child of any age to take complete responsibility for a dog. It will ultimately be the adult(s) responsible for the complete care of the dog in the home. Are you prepared to take responsibility for this dog should your child/children become disinterested?	Yes No
What reading and/or other steps have you taken to prepare for adding a dog to your home?
Who is your current veterinarian or which one do you plan on using for this dog? Please be sure to contact the vet hospital(s) you use and give permission for us to speak to them regarding your care records.
Veterinarian’s/Veterinary Hospital’s Phone Number
Do you agree to provide proper veterinary care?	Yes No
Would you be able to provide $2,000-$5,000 in medical care should your new pet become sick or get injured?	Yes No
Where will the dog sleep?
How many hours will the dog be left unattended?
Will you crate train your dog?	Yes No
How will you work through any separation anxiety issues if they arise?
When no one is home (i.e. work, shopping) where will the dog stay? (Please be specific)
How often do you travel?
What will you do with your dog when you travel? Please remember Luna’s House does offer boarding services at the MoonDrop Inn!
If you move, what will you do with your dog?
Are you or your spouse in the military?	Yes No
If deployed, what will you do with your dog?
Are you aware of the adoption fee ($250.00)?	Yes No
Please describe all animals currently living in your home (including housemates' animals). For each animal, please list species/breed, age, sex, whether they are spayed/neutered, where (s)he is kept, and how long you have had him/her.
Please describe all previous animals you had in the last ten years (those who are no longer in your care). For each animal, please list species/breed, age, sex, whether they are spayed/neutered, where (s)he is kept, and how long you had him/her.
If you have ever given away, sold, or surrendered a pet, what were the circumstances?
Thank you so much for submitting your application to adopt from Luna's House! Please click submit when you have completed your application: