Application for Adopting

Are you willing/able to participate in a virtual home visit via Facetime, Zoom, or another video-conferencing app on your computer or smartphone?*

Yes
No

Are you willing/able to have an in-person home visit done?*

Yes
No

General Information

Name*

Age

Please enter a number from 0 to 110.

Spouse Name

Spouse Age

Please enter a number from 0 to 110.

Address

Street Address Address Line 2 City State ZIP Code

County

Home Phone

Cell Phone

Email

Email is the preferred method for contacting applicants and references. Please be sure to check your email regularly after submitting your application.

Email list

Yes
No

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

Coverage Area

Family Information

Are you a veteran or active-duty service member?

Yes
No

Please list the 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.

Please list the age(s) of children who visit your home regularly and how often they visit

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

Have you applied to adopt and/or adopted from Brookline in the past? If so, when?

Home Information

Do you own your own home?

Yes
No

If no, 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.

Do you have a fenced yard?

Yes
No

Note: BLRR does not require adopters to have a fenced yard. We simply require that you have a plan to provide adequate exercise for your dog.

What type of fence?

How high is the fence?

Dog/Pet Information

Please list all pets (dogs, cats, birds, etc.) you currently own. (Include pet's name, species/breed, age and how long you have had the pet.)

Are your pets used to being around other animals?

Yes
No

If you currently own a dog (or dogs)

Are they spayed/neutered?

Yes
No

If no, why not?

Are they up-to-date on rabies vaccine and other vaccines as recommended by your vet?

Yes
No

If no, why not?

Are they tested for heartworm on a yearly basis?

Yes
No

If no, why not?

Are they given a monthly heartworm preventative?

Yes
No

If no, why not?

Please list all of the dogs you have owned as an adult, but no longer have. Please indicate why the dog is no longer with you.

Do not include current dogs or dogs you had while growing up. Include dog's name, breed, how long you had the dog, was it rehomed, deceased due to age or deceased for other reasons.

Adoption Information

What characteristics are you looking for in a dog?

How many hours per day would the dog be alone? Please provide details, if needed.

If the dog will be left alone for more than 9 hours per day, will you have someone come and walk the dog/let outside? Please provide details.

Are there any dogs on our web site that interest you?

Would you consider adopting a heartworm positive dog and seeing the dog through treatment at the rescue's expense?

Yes
No
MAYBE - would like more information

Heartworm disease is an infection in the dog's lungs and heart from heartworms. Treatment consists of a series of injections in conjunction with very restricted activity during the treatment period (usually 60 days). After treatment, dogs can resume normal activity and have no lasting effects from the heartworms.

Brookline's dogs are located throughout the tri-state area. You may need to travel 1-2 hours to pick up your dog. Are you willing to travel that distance if required?

Yes
No

Training is a requirement for most Brookline dogs. 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

Brookline operates by matching dogs with families using the information obtained in our home visits with adopters and evaluations of dogs. You many 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

How did you learn about Brookline Lab Rescue:

Adoption Event
Animal Shelter
Pets for Patriots
Friend or Relative
BLRR Website
Petfinder.com
Brookline Adopter
22 Mohawks

Please specify when & where was the event?

Please specify which shelter:

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

Reference Information

Please provide one vet reference and two personal references. Or, if you do not have a vet reference, three personal references. Only one reference may be a family member. If possible, please provide email addresses for personal references. Please call your vet and give consent to release medical information to a Brookline Lab Rescue Representative. Your Veterinarian must indicate that your pets were/are kept up-to-date on vaccinations, are seen at least once a year by a vet, and receive medical treatment as needed. If resident dogs are not on heartworm prevention or tested yearly per the advice of their veterinarian, that is acceptable; however, it is expected that a dog adopted through Brookline Lab Rescue will be placed on monthly heartworm prevention.

Veterinarian Information

Required if you have a pet or have had a pet with the last 5 years): Include your vet's name, address and phone number

Personal Reference #1*

Include name, relationship to applicant, phone number and email address.

Personal Reference #2*

Include name, relationship to applicant, phone number and email address.

Personal Reference #3 (Required if no vet reference is provided)

Include name, relationship to applicant, phone number and email address.

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 Brookline Lab Rescue. I (we) have read over the requirements for adoption on the Brookline web site and agree to their stated terms of adoption (including the home visit prior to approval). I (we) permit Brookline to contact our veterinarian and personal references.*

I (we) agree
I (we) do not agree

General Information

Family Information

Home Information

Dog/Pet Information

If you currently own a dog (or dogs)

Adoption Information

Reference Information

Authorization

How It Works