Thank you for AdoptingName of dog/cat you are interested in adopting ? First and Last Name *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountryOccupation Email *Phone *What type of home do you live in? Town HouseApartmentSingle FamilyDog/catyou are willing to adopt? *Outgoing/hyper dogShy / timid dog/catDog/cat that needs medicationDog that needs trainingDog/cat that needs groomingNone of thesePlease describe your household ActiveNoisyQuietAverageDo you have any other pets?if yes are spayed neutered? curren on vaccines? Have you ever had a pet euthanized ? if so why? Do you have a regular veterinarian? Veterinarian's information What is your idea of an ideal dog ? age, size, breed and breed you would not adopt Where will the dog spend the night?day? Number of hours( average) dog will spend alone in one day? *Do you agree to keep the dog as an indoor dog ? *When the dog goes out, how do you plan to supervise him/her? fenced yard? Do you agree to contact Rescue Mafia LA if you can no longer keep this dog? Are you willing to let a Rescue Mafia LA member visit your house by appointment? Would you be interested in fostering? Personal References *List 3 , Name, Address, Phone Number, RelationshipHow many adults are in your family? how many children? ages I understand that filling out this application does not guarantee the foster or adoption of a Rescue Mafia LA animal. I verify that all of the above information is complete and correct. Please sign using your full name below: * VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank:
