The following information is asked to determine an adoption be in the best interest of the rescued Labrador Retriever and applicant. Information must include spouse or adult partner (if applicable) as co-applicant. Be specific; additional information can be submitted by letter, sketch, photo or video to elaborate (photos returned after review). Print clearly and acknowledge every question.

 Applicant_____________________________ Co-applicant___________________________

Affiliation of Applicant & co-Applicant____________________________________________

Street/Town/State/Zip_______________________________________________________________________

Home Ph____/___________ Applicant email____________________ Co-applicant email__________________

I/we wish to adopt:    Name of Labrador_____________________________ (if known) or prefer:
            AGE:        Minimum________ years       ~     Maximum _______ years
            SEX:  (circle)     Male    ~     Female    ~    No preference
            COLOR:  (circle)   Black    ~   Yellow   ~   Chocolate   ~   No preference
            TYPE / LOOK:  (circle)   Field      ~        Show    ~   No preference

            SIZE:  (circle)    Small (65 lbs)     -    Average (75-85 lbs)    -   Large (85+ lbs.)    -    X-Large (95+ lbs.)   ~   No preference

We are seeking Lab for:  (circle)    Family companion   -   Kids    -    Companion for other pet   -   Breeding    -   Show   -    Agility   -

       Therapy Dog   -    Assist  -   Service Dog  -   Hunting  -  Protection  -   Other ________________________________________

ACTIVITY LEVEL:  The energy level of my new dog should be:  (circle one)

             (1)   Low  (leash walk only if necessary; infrequent play; infrequent training)
             (2)   Fair (short walks combined with play or training two or three times daily)
             (3)   Moderate (3 or 4 lengthy walks, play and/or training every day)
             (4)   Consistent (regular vigorous exercise; extremely long walks, vigorous play or training; Lab will be a "working" dog)

When do you want to adopt (keep vacations, guests, parties and work schedules in mind)_______________________________

Number of household residents__________  Ages of minors_________________________________________(mo./yr)
Are minors used to living with and interacting around large breed active dog: YES   NO
Is any household member frail, in failing health, or have special needs:    YES   NO
Does any household member have reservations about adopting:   YES   NO
Have you visited municipal shelters for Labradors needing to be adopted: YES   NO
Will you consider a disabled Lab (blind, seizures, amputee, diabetic, deaf, arthritic): YES   NO

Some rescued Labs are behind in formative training and may dump trash, jump on greeting, steal  food from counters and table, swipe food from toddlers hands, rearrange pillows, rugs magazines, rugs, and chew forbidden objects. Training begins in the foster home and requires human understanding, persistence, patience and time.  Are you willing and able to continue this training:  YES  ~ NO

Tell us about your interest in and experience with this breed and why you seek to adopt from rescue:

____________________________________________________________________________________________________

How much do you think it will cost to care for this pet each year? (diet/nutrition, treats, toys, bedding, vet care, inoculations, medications, monthly preventatives, worming, grooming, licensing): $__________    (not including cost of chewed shoes, etc.)

Primary caregiver and daily training of the new dog will be provided by:___________________________________________

If the adults in your household become ill, disabled or deceased, who will care for this dog:

            Name________________________________ Phone_______/________________

What unusual or special circumstances will the new dog need to adapt:____________________________________________

 I/we: (circle)  Own -  Rent              House -  Apt/Condo - Other______________________     What floor is apt/condo on?________

            Years/months at current residence: ________years        _________months

            Our neighborhood is:  (circle)  metro/city   -   village   -   suburbs    -    country    -    resort
            Locale: (circle) inland - mountain - waterfront - other__________________________________________

            Renters: landlord name:_______________________________________________ Phone:_______/_______________

Address of weekend/summer/2nd residence ________________________________________________________________

____________________________________________________________________  Phone_______/_______________

If for any reason you move from your current residence, are you willing and able to provide additional security deposits that may be necessary to secure new housing that will accept/include your dog:  Yes  -  No

Pets now residing at your home:  (continue on reverse for other pets)
     Pet #1  Breed: __________________________   Name:  ______________________
                Sex:   Male  ~  Female  Age:______________  Neutered/spayed:  Yes  ~   No
                House or yard pet: ___________  Health  problems:____________________________
                Weight: _______ lbs.        Diet:___________________________________________
                Is pet current on inoculations:  Yes ~  No  Is pet licensed by state:  Yes ~  No
                Pet's vet/clinic:_________________________________ Phone:_____/_____________
                Are you certain this pet will welcome an unfamiliar dog into the family home:  Yes   No
                Describe any behavior problems of this pet:_____________________________________________________

 Pet #2  Breed: __________________________   Name:  ______________________
            Sex:   Male  ~  Female  Age:______________  Neutered/spayed:  Yes  ~   No
            House or yard pet: ___________  Health problems:____________________________
            Weight: _______ lbs.        Diet: ____________________________________________
            Is pet current on inoculations:  Yes ~  No  Is pet licensed by state:  Yes ~  No
            Pet's vet/clinic:_________________________________ Phone:_____/_____________
            Are you certain this pet will welcome an unfamiliar dog into the family home:  Yes   No
            Describe any behavior problems of this pet:_____________________________________________________

What pets have been part of your family in the past 10 years: ____________________________________________

         How many of those pets died or were given away: ___________________________________________________

         What caused their death or why given up: ___________________________________________________________

Do your neighbors have dogs:  Yes ~  No                                 Do their dogs roam the neighborhood:   Yes  ~  No
        Are there dangerous or vicious dogs in your neighborhood:  Yes  ~  No
Define your town/county dog ordinance_______________________________________________________________
Have you ever been convicted of animal abuse or not abiding dog laws: Yes - No

Dog related clubs, organizations, classes, and/or rescues you support:_____________________________________

Do you own or co-own any dogs for breeding:  Yes-  No     (If yes, enclose copy of your sales contract and define your breeding policy.)
Are you aware that rescued Labradors are spayed/neutered prior to adoption, age permitting: Yes - No
If you adopt a rescued Labrador too young to neuter/spay, are you aware and agree the Lab will not be bred and to neuter/spay at six months of age:   Yes -  No
Will you acquire professional training with the new dog:  Yes ~  No            Have you professionally trained another dog:   Yes  ~  No
How many hours per day will you spend to interact, socialize, train the new dog:___________ hrs.
What family activities will include the dog:________________________________________________________
Where will you request the dog sleep nights:________________________________________________________
Where will you keep the dog when he is left alone:__________________________________________________
How many hours  will dog be without ADULT supervision in a normal 24 hr. work day:_______________________
Who will care and supervise dog when the adults are not at home:____________________________________
Will a dog walker to feed, water, exercise and tend to dog's needs while adults work:  Yes  -  No
             Name of dog walker: ____________________________  Phone:_____/____________
Will dog be restricted from certain areas of your home:   Yes -  No            Which areas:______________________________________

Will you crate the dog if necessary:  Yes   ~   No    Size of your crate:_____________________
Who will care for the Lab when you travel:__________________________________________________________
Where will the dog ride in your automobile:_________________________________________________________

Conventional Fence:

On separate paper or reverse side, sketch or describe the yard to which the new Lab will have usual  access.

Define yard size, fence styles and fence heights.   Indicate potential problem areas and elaborate extra safety measures.

Invisible Fence:

 Date installed_____________    Installed by:___________________________  For what breed/s_________________________
Company__________________________________  Phone_____/____________ Rep_________________________

 Applicant occupation___________________________ Employer____________________________________________
        Work phone______/_______________    Address_________________________________________________________
        Length of employment there: ___ years ___ months      Can you be contacted at work:  Yes   ~   No

    Normal work schedule:____________________________________________________________________

       Do you often work overtime?  Yes   ~   No                Do you have additional or part time employment:  Yes    ~    No

Co- applicant occupation___________________________ Employer________________________________________
        Work phone______/_______________    Address_________________________________________________________
        Length of employment there: ___ years ___ months      Can you be contacted at work:  Yes   ~   No

        Normal work schedule:____________________________________________________________________

       Do you often work overtime?  Yes   ~   No                Do you have additional or part time employment:  Yes    ~    No

Name of your intended veterinarian:__________________________________  Clinic:___________________________________

        Clinic address:_________________________________________________________ Clinic phone:____________________

Provide three references capable of attesting to your ability to provide a caring and responsible home for the Labrador Retriever:
         Name____________________________  Ph_____/_____________    Affiliation___________________________
        Name____________________________  Ph_____/_____________    Affiliation___________________________

        Name____________________________  Ph_____/_____________    Affiliation___________________________

Have you applied with other rescue groups, leagues or animal shelters:  Yes ~  No

       If yes, which Rescues/shelters:_________________________________________ Phone____/_____________

How did you learn of LILRR: ______________________________________________________________________

May we visit you at home (by appointment) and verify information provided herein:   Yes    ~    No

    By signature below, I/we attest no household resident is known to have canine irritated allergies or asthma.  I/we further attest the home yard is fenced dog safe.  I/we have read and understand and agree to all terms within the Adoption  Agreement.  I/we understand LILRR reserves the right to refuse, without explanation, the placement of a dog with  applicant.  I/we understand and agree that any misrepresentation or untruths of information provided herein will  invalidate any future adoption agreement and will give LILRR the right to reclaim the Labrador Retriever without  resorting to court action.

_________________________________________________________________________________________________
             Signature Of Applicant                                                Date                                           Date Of Birth

_________________________________________________________________________________________________
             Signature Of Co-Applicant                                          Date                                           Date Of Birth

In support of LILRR endeavors, enclosed is a donation of $__________

Do not send cash.    Retain check for tax purposes.  Receipts automatically provided for donations of $250 and greater.

Donations are tax deductible to the extent of the law, directly applied to Rescue endeavors and not refundable.

Print, complete, sign and submit by US Mail to:

 LILRR

 P. O. Drawer 3011

Shelter Island, New York  11965-3011