Little Blessings Pet Rescue

Rescue and Adoption of Abandoned Pets

Please Note, Our Rescue Requires a Home Visit

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Little Blessings Pet Rescue

Rescue and Adoption of Abandoned Pets

Phone: 206.473.1111 Email: adoptions@littleblessingsrescue.vpweb.com

Application for Adoption

Please Provide Your Contact information

We are glad you are considering adopting a new pet through us. We are looking for the right fit and providing this information will help us to make the right placement for you and your family. To be considered a potential adopter, you must meet the following criteria. However, if you do not meet one of the following criteria for adoption, but feel you are still the right home for the dog you are applying to adopt, please don't let these guidelines stop you from applying. We adopt each dog on a case by case basis and WILL make exceptions for the RIGHT home!

The following information is requested so that your adoption counselor may assist you in the selection of a new pet. The consultation process is designed to help us determine if the adoption is in the animal's best interest and to assist you in finding an animal most compatible with your lifestyle.

**If you would like to add a personal touch to your application by submitting a picture of yourself/family, house and yard, it would be appreciated.**

Applicants for adoption must:

  • Be at least 25 years old
  • Be age appropriate for the age of the animal you are choosing
  • Have identification showing your present address
  • Provide vet and personal references
  • Be able and willing to spend the time and money necessary to provide vaccinations, medical treatment, training, grooming and proper care for a pet
  • All family members need to be present when meeting
  • Not be adopting an animal for a gift or on behalf of someone else
  • Agree not to chain the animal outdoors
  • Not have had an animal that has died of any contagious disease within the last 6 months
  • Return the animal to an appropriate party of the above named rescue org. if, for any reason, you are unable to keep
  • Consent to a home visit, with prior notice at a mutually agreed upon day and time
  • Have no criminal record for animal abuse or any other violent acts, nor does anyone in your household and will agree to a criminal background check if asked
  • Have not abused, breed or sold a pet in the past for profit or for animal experiments, nor has anyone in your household
  • Do not have an electrical fence or use any device made to shock to train
  • Be physically able to exercise and control a pet when outdoors
  • *if you are currently a tenant (renter), must have the knowledge and consent of your landlord, and must provide contact information for your landlord for verification by Little Blessings adoption counselor prior to adoption
  • If you meet the above qualifications, please complete the following:


Why are you interested in this/these particular Pet(s)?

Please state the reasons you wish to adopt this pet.__________________________________________________________________________________________________________________________________________

Are you prepared to adopt a dog today? _____________________________________________________________________________________________________________________________________________

Is there anything you need to do, or that needs to be done before you can adopt?_____________________________________________________________________________________________________________________________________________

What expectations do you hold for your new dog? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

About you and your family

Please list all of the members in your household along with their ages: ___________________________________________________________________________________

Do you consider yourself/family to be high energy, medium, or low energy? What are your favorite activities? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Is anyone in the family a smoker?____________

Do you or a family member, who would be a main care taker of the dog, have any serious health issues that may interfere with the care of your dog?____________________________________________________________________________________________________________________________________________

Who would care for your dog if you became ill, or died? Please include their names and their phone numbers.

_____________________________________________________________________________________________________________________________________________

Are you or someone in the family currently employed? No_____Yes______If yes, where?___________________________

What are your work hours?______________________________________________

Are you able to bring a dog to work? Yes _____ No_________

If yes, please share your company's HR policy regarding bringing dogs to work:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you or anyone in the family travel for their job? Yes:___No___If yes, how long are you typically gone?___________________________________________

Is this your first experience with a pet? Yes _____ No _____

If no, have you had this type pet before?__________________


What method will you use to train your dog?______________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________

Will you be willing to help potty train, or work through any issues with your dog? Yes/No__________________________________________________________

If there are children in the household, what are their ages? Have they cared for an animal before? If yes, do you feel they were kind and gentle? Have they been taught how to approach a dog? ______________________________________________________________________________________

Is anyone in your household allergic to animals? Yes ____ No ____

If yes, have you re-homed an animal because of allergies?________

Has a pet in your care been lost? Yes______No____If yes, what was the outcome and what measures did you take to find the animal?__________________________________________________________________________

Has a pet under your care died in an accident or a hot car?__________________________________________________________________________

If yes, what precautions will you take now to insure your pet's safety?__________________________________________________________________________

__________________________________________________________________________

Have you ever relinquished a dog because of a move or an illness? Yes______No___________

If yes, where did the dog go? Please explain:______________________________________________________________________________________________________________________________________________

Is everyone in your family in agreement to adopting a new dog? Yes__No__

If not why?_____________________________________________________

Is your new pet going to be an indoor or outdoor pet?______________________________

When home alone, the animal will be: Please Choose one:

  • In a crate
  • In an outdoor kennel or pen (specify size)
  • Loose indoors
  • Loose outdoors
  • Tied up outdoors
  • Other (please specify):
  • Other provisions or size of enclosure:

How many hours a day are you, or your family gone from home?__________

Where will the dog stay while you are at work?__________________________________________________________________________

If you work, what plan do you have in place for the dog to have potty breaks and stimulation? Please be specific.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

When working, where will your dogs stay? Home___/Doggie Daycare___/With family member___other________

How much time do you/your family have to devote to a dog a day?________

Are you on a limited budget?_________

If so, how do you plan on paying for the vet care of your dog?__________________________________________________________________________

Are you anticipating a move in the next few years? Yes__No___

Please provide two personal references other than family members:

1. Name___________________________

Address:___________________________

Phone number:______________________

2. Name__________________________

Address:___________________________

Phone number_______________________

  • Your current pets
  • Do you own any pets at the present time? Yes____ No ___ If yes, please list the following: Type(s) (dog/cat), name(s), Breed(s), Age(s), Sterilized, Declawed, Inside or outside: ______________________________________________________________________________________________________________________________
  • How many dogs or cats have you owned in the past 10 years? Dogs: ______ Cats: _____________________________________________________________________________________________________________________________
  • What other pets have you owned in the past 10 years? _______________________________________________________________
  • Do you still have these pets? Yes _____ No _____ If not, what happened to those pets?___________________________________________________________
  • (Be specific, include name, breed, ages, health, died of old age, fatal disease, sterilized, hit by a car, stolen, disappeared?) ______________________________________________

Have you relinquished an animal to a shelter or another rescue in the past? Yes-No

If yes, please explain:________________________________________________

  • Have you ever had an animal euthanized? Yes ___ No ______ If yes, why? ______________________________________________________________________________________________________________________________
  • Name of your current veterinarian or one you have used in the past: Veterinary phone number: _______________________________________________________________
  • May we call your veterinarian for a reference? Yes_____ No _____ If no why?:_________________________________________

About your residence

Do you currently reside in a: House__ Apartment__ Mobile Home__ Duplex__ Condo__ Other__

Do you (please select one): Own ___ or Rent __

If you rent, does your lease allow pets? Yes___ No ____

If renting, when do you anticipate moving?:__________________________________________________

(please note: must have landlord approval PRIOR to adopting your new pet)

Renters, please provide your landlord or Property Managers contact information: Landlord/Property Manager name: Phone number(s): _____________________________________________________________________________________________________________________________________________

I have permission from my landlord to own a pet:Yes_No_


Do you have a dog-door? Yes _____ No _____

Is your yard fully fenced? Yes _____ No _____

If fenced, how high is the fence? _____________________________________________________________________________________________________________________________________________What material is your fence made of?_____________________________________________________________________________________________________________________________________________

Are there holes or areas of your fence needing repair? __________________________________________________________________________

If your yard is not fully fenced, how do you plan on keeping your dog safe outside?_____________________________________________________________________________________________________________________________________________

Are there any dogs living next door to you? Yes___No_____

If yes, what are their breeds? Are they well cared for?______________________________ __________________________________________________________________________

Will you leave the dog alone in the yard? Yes_____ No_______

Where will you take the dog for daily exercise?:_____________________________


Many of our dogs have hair instead of fur which needs consistent grooming. Where will you have your pet groomed? _______________________________________

Where will the dog stay/board during vacations?________________________________________________

Where will you purchase your dog food? ________________________________________

What type of preventative do/will you use for fleas?__________________________________________________________________________

When you travel with your pet, how will you secure him/her? Please explain: ___________________________________________________________________________________________________________________________________________

Do you have a job that would require you to move?__________

What will you do with your pet if you move? ___________ _______________________________________________________________ _____________________________________________________________________________________________________________________________________________


*By my action of submitting this form, I certify that the above information is correct and I clearly understand that providing false information will result in the forfeiture of my adopted pet. Any legal expenses to Little Blessings Pet Rescue to regain custody, will be paid by me.

Please Initial Here: ___________