DLux Pets Adoptions & Sanctuary
 Application to Adopt a Dog
To adopt one of our dogs, you will need to fill out the application form COMPLETELY
Items marked in RED are required information. Failure to complete the application in full
will result in a delay in your approval.
Tell us about the children:
Name, age, gender, likes/dislikes
I want to adopt this dog for (check all that apply)
Where will the dog live?  (check all that apply)
If you rent, we need verification that you are allowed to
have pets.   Please provide Landlord name & phone number
Does anyone in your family have allergies?  Explain
Owning a dog is a serious responsibility. The average life expectancy of a dog is more than ten (10) years.
During that time s/he will need yearly visits to the vet for rabies shots & registration tags,  items which
are required by law whether the pet goes outdoors or not. S/he also needs annual vaccination updates &
most dogs will require a dental procedure every year or two. The dog will need heartworm preventive
EVERY month for the rest of its life & will probably need Flea/tick preventions also. The pet will need
accomodations if you go on vacation & cannot take him/her or if an emergency befalls your family & no
friend or family member is available to care for the pet. Depending on the type of dog & your ability to
groom it at home, a professional groomer might also be necessary.
These expenses are in addition to food, toys, treats, collars, leashes, beds, dishes, possible unexpected
medical requirements, damaged items due to the dog/puppy.
Typing your name in the box below is the electronic equivalent of a signature. By affixing your signature
to this application you are agreeing to provide the necessary medical, emotional & physical care for the
pet you are applying to adopt. You are also agreeing to allow our representative to visit your home
before the adoption is complete & to allow follow up visits if deemed necessary. Completion of this form
DOES NOT mean you have been approved for the adoption. You will be contacted to go over the
application with you & discuss the pet & any questions you may have.
Name of the dog you want to adopt:
Information About You & Your Family
Your full name - First & Last
Co-Applicant's Full Name -First & Last
Your Street Address
City, State & Zip
Home Phone - Include Area Code
Cell Phone - Include Area Code
eMail Address
Where do you work?
Where does Co-applicant work?
Driver License w/ state issued
Your Date of Birth
Co-Applicant's Date of Birth
How many adults at home?
Number of children?
Do you have pets? Check all that apply
If none, why not?
Dogs?
Cats
Birds
Fish
Reptiles
Other
Companion for self
Companion for elderly person
Companion for child
Hunting dog
For athletic activities
Guard dog / Protection dog
Dog house outdoors
Fenced Yard
House
Garage/Patio
Veterinarian's Name & Number
Describe where you live: