TLC Rescue PA

Adoption Application

Applicant Information
Applicant Name *
Address *
City State Zip *
Email *
Date of Birth *
Home Phone *
Cell Phone
Current Employer *
Work Phone
Pet Information
Select or type the name of the pet(s) you would like to adopt *
If you are undecided type: Undecided
Physical description of the pet
Any details for the type of pet you are looking to adopt
Optional: Select any specific breeds you are interested in.
The purpose of this dog is: *
Household Members

Pet History (all dogs or cats owned in the past 10 yrs)

Household Information
Do any members of your household have allergies to dogs?
Have all the dogs and cats listed above been spayed or neutered?
Have all the dogs and cats listed above been kept up to date on vaccinations?
What type of home do you live in?
How long have you lived in this home? (please provide a numeric response such as 0.5, 1, 3, 10 for number of years below)
* years
Do you own this home?
Landlord or Homeowner Name
Landlord or Homeowner Phone Number
Would you allow us to visit your home prior to finalizing your application?
Do you have a fenced in yard?
Fence Height (in feet, please provide a numeric response such as 4, 5, 6 below)
What is the fence constructed of?
Have you ever rehomed, surrendered or returned a pet?
Personal References

Reference Name
Phone #
Reference Name
Phone #
Vet History

The Fine Print
  • There is no fee or obligation to adopt associated with this application.
  • Submission of an application is not a guarantee of approval to adopt.
  • Applications are processed in the order in which they are received.
  • Notification of approval or denial will be sent by email to the address in the first section, unless otherwise requested in writing.
  • TLC's approval or denial of an application is final. Denial does not require an explanation or justification.
  • Approval notifications are sent on an as-approved basis.
  • The first step of our process is an interview with the applicant. Then veterinary and personal references are contacted. Our volunteers work to process all applications in a timely manner. This processing time is largely dependent on the availability of the applicant and the references provided in this application.
  • Pre-approved applicants and previous adopters do not need to complete a new application unless there has been a significant change in the information herein.
  • TLC does not hold dogs for unapproved applicants.
  • The applicant is responsible for providing accurate information in this application. Providing false information may make you ineligible to adopt from TLC.

By accepting these terms you certify that all information contained herein is complete and accurate. You also understand and agree to the points bulleted above.

Date: 04/24/2018