Adoption Application

First Name

Last Name

Phone

Occupation

Address - including City and State. (We do not adopt outside Southern California)

Do you rent or own? How long have you been at this address?

How many adults are there in your family (their relationship to you)?

How many children in your home (ages)?

Does your home have a backyard? If so, how tall is the fence?

If you rent, please give the rules governing pets and the landlord's name and number (by providing this information you are allowing Southpaw to contact your landlord. Pleaswe inform them of this call so they will speak with us):

What other pets do you have (specify type and number)?

Have you ever surrendered a pet? If so, why?

How do you discipline your pets and why?

If you have a vet, please provide below the vet's name, clinic name, address and phone number (By providing Southpaw with this information you are giving permission for Southpaw to call your vet. Please call your vet and authorize them to speak with us.):

Do you have a specific dog you are looking at in Southpaw? If so, who:

Desired breed(s):

Breed(s) you won't adopt:

Number of hours (average) dog will spend alone?

Where will the dog spend the day? (describe)

Where will the dog spend the night? (describe)

Who will have primary responsibility for this dog's daily care?

Who will have financial responsibility for this dog?

How did you hear about Southpaw Rescue?

Your Signature

Select a date

Thank you for choosing rescue and submitting an adoption application. Someone will get a hold of you shortly!