Application for Adopting

General Information

Name*

Age*

Please enter a number from 0 to 110.

Spouse Name

Spouse Age

Please enter a number from 0 to 110.

County*

Phone 1*

Phone 2

Email*

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

Coverage Area

Family Information

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

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.)*

If you currently own a dog (or dogs)

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?*

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 one personal reference. Or, if you do not have a vet reference, two personal references. 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 (cannot be a relative)*

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

Personal Reference #2