Name of dog you are
interested in adopting:
Date: 4/27/21
Drivers license number: b6699136
Name: Jason DeBonis
Spouses Name: Katrina DeBonis
Address: 701 Haverford Ave
City: Pacific Palisades
State: CA
Zip Code: 90272
Home Phone: 9175756534
Work #
Cell #:
Email Address (valid email is required): [Link]@[Link]
Are you over 18 years old? : y
Are you a student? : n
Occupation: physician
Employer:VEP
Employer’s street : Wilshire
City: Santa Monica
State: CA
Zip: 90404
How long have you lived at this address? : 11 yrs
Type of current home: home
Type of street: normal
Have you checked with your landlord or homeowners’ association regarding permission
to have a dog?yes
Does the city you live in have any breed restrictions? : n
Do we have your permission to contact your landlord?
Landlord’s Name: Landlord’s Phone #:
How many adults in the household? :
How many children?: 2 Child: Ages: 9, 7
Why do you want to adopt the dog : love dog
Do the other members of your household understand the time and possible financial
goes into caring for adopted animals and are they in agreement with you regarding the
care of animals you are adopting? : y
Have you adopted a dog before?: y
Have you ever surrendered a dog to a shelter or rescue group?: n
Have you ever adopted a dog from a shelter or rescue group?: y
If “Yes”, what rescue group or shelter did you adopt from? Much love animal rescue
Will this dog be enrolled in obedience classes? Other training?: y
Will this dog be chained or tied outside? : never
Where will the dog be kept most of the time? With family
What type of outdoor shelter will you have for the dog? Home
Will the dog be crated? : Probably How many hours a day? Y
Do you have a fenced yard?: y
Is there any type of lock on the gate(s)? no
What type?
Who has access to your yard? : home
If “Yes”, please describe the type and height of fence: regular
Do you have a pool or deep pond? : not yet
If “Yes”, is there a fence around it? Yes there will be
Where will the dog sleep (please be specific);
How many hours will the dog be alone each day?: 0
Where will the dog be kept when alone?
How soon after the dog arrives home will it be left alone? not
How often do you travel? : not
How do you plan to provide for the dog when you are out of town? ; infrequent
Is anyone in your household allergic to dogs: no
If “Yes”, are they on medication that can control their allergies?
How would you rate your level of dog owning experience?; high
How do you normally walk your dog?: good walk on leash
How often do you walk your dogs?: 3-5x/day
What animals do you currently own? None
# of Dogs : # of Cats
Breed/s:
Have they all been spayed and/or neutered? :
Are they all current on their vaccinations? :
Other animals?:
Do you object to an inspection of your premises by a rescue representative? ; no
Veterinarian:
Name and Address: Palisades Vet
Phone #: 3105737707
How did you hear about us? : petfinder
Word of Mouth
Friend/Family
TV
Radio
Magazine
PetFinder
Craig’s List
Adoption Event
1-800-Save-A-Pet
Pets911
Other: Please specify:
Will you be willing to sign your new dog up for Obedience classes at your own
expense? YES
Pets are an investment of your time and money. Can you afford to provide medical
care, grooming, proper diet, shelter and exercise for your new pet? YES
Are you able and willing to make a long-term commitment to care for your pet for its
entire life span, which could be 15 to 20 years? YES
What reason would prompt you to give your dog up? none
If your present relationship was to change or there was a death in your family, with
whom will the dog go?: family
I understand that a home visit is required prior to final placement. I understand that a
home visit does not guarantee placement. I understand that the donation or
contribution is a gift given freely and not a purchase price for a dog and is not
refundable.
PERSONAL REFERENCES (PLEASE DO NOT INCLUDE FAMILY):
Name: Aaron Leiderman Phone #: 6466451048 Relationship: friend
Name: Nicholas Zeitlin Phone #: 9175837415 Relationship: friend
Which of the following reasons might prompt you to give up your dog? None
If a problem with the dog’s behavior arises would you be willing to seek help
immediately from the rescue group and/or trainer we refer? YES
______________________________________________________________________
________________________________
If you work with one trainer and their training techniques are not effective, would you be
willing to get a second opinion? YES
____________________________________________________________________
Would you agree to consult and pay for a trainer or behaviorist if any problem
develops?
YES
I understand that the Rescue is an all-volunteer group. I understand a donation of
$400 is required to help offset costs incurred to rescue and care for each dog.
Because most animals cost us more than the minimal donation to care for, we welcome
you to make a larger donation if you are [Link] Fees Are Non-Refundable.
Print name/s: ___________Jason DeBonis, Katrina
DeBonis__________________________________________________________
Signature/s:
______________________________________________________________________
Date: 4/27/21
_________________________
Norma Valencia
(323)926-6673(only text)
Xochilt Delgado (Adoption Coordinator)
Puppyandpalsrescue@[Link]