Adoption Application

Our Coverage Area

Please sign with your initials to confirm that you are aware of our coverage area which is one hour from Warrington, PA*

General Information

Name*

Age*

Spouse Name (If Applicable)

Spouse Age

Address

Street Address City State Zip Code

Phone*

Email*

Do we have your permission to add you to our e-mail announcement list?

Yes

No

Family Information

Name(s) and age(s) of adults currently living in your home other than those listed above.

Please list the name(s) and age(s) of children currently living in your home.

Have the children listed above been around dogs before and if so, how are they with dogs?

Why do you wish to adopt this dog?

Does everyone in your household support your intentions to adopt a dog?

Home Information

Do you own your home?

Yes

No

If not, please provide the volunteer who does your home visit with a copy of your lease or a signed letter from your landlord (with contact information) showing that your lease allows pets.

What type of home do you live in?

If you rent, does your home allow pets?

Are there restrictions on breed, size and how many pets you are allowed? If so, please list them.

Do you have a fenced yard?

Yes

No

Notes:

Jax's does not require adopters to have a fenced yard. We simply require that you have a plan to provide adequate exercise for your dog.
Jax's does not accept invisible/electric fences as a safe way to contain a dog. If you have this type of fence and are currently using it for your pets, your application will not be approved. Jax's believes in positive force free training tools without using pain or fear.

If yes, what type of fence?

Chain Link

Wood

Vinyl

How high is the fence?

Dog / Pet Information

Please list all pets (dogs, cats, birds, etc.), their species, breed, age, and how long you have owned them.

Are your pets used to being around other animals?

Yes

No

If you own dog(s) are they spayed/neutered?

Yes

No

If no, please explain why:

Please list all of the dogs (breed, age) you have owned as an adult, but no longer have and indicate why the dog is no longer with you. (Do not include current dogs or dogs you had while growing up.)

Adoption Information

What characteristics are you looking for in your new dog?

Are there any dogs on our website that interest you? If so, please list their name(s).

What is your preferred level of energy and exercise requirements in your new dog?

Preference (Size)

Preference (Age)

Preference (Male-Female)

Dog Preference (Breed)

Would you consider adopting a dog with special needs – one that is required to have medication or special training?

Yes

No

Jax's dogs are located throughout the tri-state area. You may have to travel 1 hour to pick up your dog. Are you willing to travel that distance, if required?

Yes

No

Training is a requirement for most Jax's. This can be done via group classes or in-home training, whichever is more appropriate for the dog. Are you willing to attend training sessions with your new dog?

Yes

No

Jax's operates by matching dogs with families using the information obtained in our home visits with adopters and evaluations of dogs. You may not be matched with the first dog that interests you. Are you willing to wait for the dog who is the best match for your family?

Yes

No

Have you ever had to give up an animal for any reason? If so, explain:

Which of the following behaviors present a problem for you: (Check all that apply)

If you have pets, are they current on their rabies vaccine and any other vaccines recommended by your vet? (Please list all vets you have used for your vaccines and wellness visits etc.)

Are they given monthly heartworm preventive and flea and tick preventive?

Tested yearly for heartworm?

If you must move, what will you do with your adopted dog?

If your pets survive you or you are no longer able to care for them, what will happen to them? Who would be responsible for them?

How do you plan to meet the needs of your adopted dog as it ages?

How many hours during the day will the adopted dog be alone? (If longer than 4 hours for a puppy/young dog or 9 hours for adult dog, what is your plan to give the dog a potty break/exercise?)

If you work from home, where will the adopted dog spend it’s time while you are working? If circumstances change and you start working out of the home, what will you do with your adopted dog?

Please list any additional information you would like to share and/or any questions you have.

Reference Information

Please provide one vet reference and two personal references OR if you do not have a vet reference, three personal references.

Personal Reference #1 Full Name*

Personal Reference #1 Phone*

Personal Reference #1 Email*

Personal Reference #2 Full Name*

Personal Reference #2 Phone*

Personal Reference #2 Email*

Name of Veterinarian*

Veterinarian Phone*

Veterinarian Address

Street Address City State Zip Code

Optional - 3rd Reference

Personal Reference #3 Full Name

Personal Reference #3 Phone

Personal Reference #3 Email

Authorization

I (we) attest that the information provided is true and accurate to the best of my (our) knowledge. I (We) understand that completion and submission of this application does not guarantee adoption of a dog from Jax's Lab Rescue. I (We) have read over the requirements for adoption on the Jax's web site (www.jaxslabradorretrieverrescue.org) and agree to their stated terms of adoption (including the home visit prior to approval). I (We) permit Jax's to contact our veterinarian and personal references.

Authorization*

Yes

No

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ADOPTION APPLICATION