Step 1 of 4 25% Adopter InformationAdopter Name* First Last Date of Birth* Month Day Year Spouse or Co-Applicant Name First Last Spouse or Co-Applicant Date of Birth Month Day Year Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Phone*Cell Phone*Applicant Employer Spouse or Co-applicant Employer Household InfoHome Ownership Own Rent Other Residence TypehousecondoapartmentduplexfarmotherHomeowner Name First Last Homeowner PhoneLandlord Name First Last Landlord PhoneDo all adults in your household know that you plan to adopt? Yes No Number of Adults in Home Number and ages of children in home What type(s) of pet(s) have you owned during the past five years?Type/BreedAgeNameSpayed/Neutered? (Yes/No)Still Own? (Yes/No) If you have a veterinarian, please provide his/her name and the clinic name. I have owned a dog before: Yes No The last time I had a dog was:within the last year2-5 years ago6-10 years agomore than 10 years agoneverMy dog needs to get along with my other dogs: Yes No If yes, list their names, ages, genders and breeds (if other than animals listed above):NameAgeGenderBreed My dog needs to be good with (check all that apply): Children over 8 years old Children under 8 years old Elderly people Cats Animals other than cats and dogs Info that will help find the right dog for adopter.My dog will primarily be an: Inside Dog Outside Dog How many hours will your dog spend outside per day:2 hours or less4 hours or less4-8 hours8-10 hrsmore than 10neverMy dog needs to be able to be alone:2 hours or less4 hours or less4-8 hours8-10 hoursmore than 10 hoursneverWhen I'm at home, I want my dog to be able to be by my side:all the timesome of the timea little of the timeWhen I'm not at home, my dog will spend his time:loose in the housecrate in the houseoutsidegaragerestricted to a room in the houseI want a guard dog: Yes No I want my dog to hunt or herd with me: Yes No I want my dog to be the type that is very enthusiastic in the way s/he shows s/he loves people:verynot at allsomewhatI plan to exercise my dog by:leash walkingloose in fenced yardtrolley systemchained out outside kennelloose in unfenced yarddog parkI would describe my household environment as:very activeactivesomewhat activevery little activityI expect my dog to be:must be housebrokenprefer housebrokendoesn't matterI want my dog to be playful:verynot at allsomewhatI want my dog to be laid back:verynot at allsomewhatI am comfortable doing some training with my dog to improve manners such as jumping, stealing food and pulling on the leash:somewhatnot at alla lotI (or my children) want to compete in Agility, Flyball or Obedience with our dog: Yes No I would consider a dog with "special needs" (medical or behavioral): Yes No I am willing to attend an obedience or socialization course with my dog:neveronly if neededonly if required by LakelandI plan to attend even if not needed or required by LakelandHow often do you plan to take your dog to the veterinarian:only as neededat least annually but more if neededat least every other year but more if neededonly in an emergencyHow much do you think you'll spend yearly for the care of your dog? (Food, medical care, boarding, toys, etc.): If I can no longer keep my dog I will:give awaysellreturn to sheltergive to a family memberlet looseI plan to give my dog ___________ to adjust to my house and family:less than a week1-2 weeks2-4 weeks4-8 weekshowever long it takesIf I have adjustment issues with my dog I will:work with a professionalcall Lakeland for advicereturn the dog to the sheltergive the dog awaywork through the issues on my ownName of Animal Interested in Adopting Please tell us why you are interested in adopting this animal and why you feel they would be a good fit for your family.Please share with us any additional information you would like concerning your family and the dog you would like to adopt. Terms & ConditionsI certify that I am at least 18 years of age and the information I have given is true. I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal and I understand that the Lakeland Animal Shelter has the right to deny my application. I am fully aware that I am adopting a living creature and as such that the Lakeland Animal Shelter is unable to guarantee the health of the animal. If this animal becomes ill, I certify that I am financially and/or emotionally prepared to treat this animal at my own expense.I have read and agree to the terms and conditions.* Agree CAPTCHANameThis field is for validation purposes and should be left unchanged.