Adoption Application

General Information
Full Name *
Full Name
Spouse Full Name
Spouse Full Name
Address *
Address
Phone *
Phone
Family Information
Write N/A if none
Write N/A if none
Write N/A if none
Write N/A if none
Home Information
If not, please provide the volunteer who does your home visit with a copy of your lease or a signed letter from your landlord (with contact information) showing that your lease allows pets.
Note: Jax's does not require adopters to have a fenced yard. We simply require that you have a plan to provide adequate exercise for your dog.
If yes, what type of fence?
Dog/Pet Information
Adoption Information
If yes, please list dog's name
How did you learn about Jax's Lab Rescue?
Reference Information
Please provide one vet reference and two personal references or, if you do not have a vet reference, three personal references. If possible, please provide email addresses for personal references.
Personal Reference #1 *
Personal Reference #1
Please enter Personal Reference # 1 Full Name
Personal Refernce #1 Address *
Personal Refernce #1 Address
Personal Reference #2 Full Name *
Personal Reference #2 Full Name
Personal Reference #2 Address *
Personal Reference #2 Address
AUTHORIZATION

Application Fee: 

 

In order to process your application, Please use our PayPal Pay Now button

 

Or mail check/money order for $25 payable to “Jax's Lab Rescue” to:

Jax's Lab Rescue
1833 Meadowbrook Rd.
Feasterville Trevose, Pa 19053-3310