Adopter Update Form

Please complete this form only if you are previously approved and have been instructed to do so by LAHPSTR.

Lend A Helping Paw Shih Tzu Rescue Adopter Update Form

For an approved adopter to submit updated information

- Step 1 of 2

Have you previously been approved to adopt from Lend A Helping Paw Shih Tzu Rescue? *

• Yes
• No

Date of approval, if known

Have you previously adopted a dog or more from us? *

• Yes
• No

Next

Name *

First

Last

Email *

Email

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Occupation *

Work Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Co-Applicant

Co-Applicant's Name

First

Last

Co-Applicant's Email

Email

Confirm Email

Co-Applicant's Phone

Is address same as above?

• Yes
• No

Co-Applicant's Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Co-Applicant's Occupation

Co-Applicant's Work Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Current Pets

How many pets (dogs, cats, other) currently live in the household? *

Pet 1

Name *

Type of Pet *

• Dog
• Cat
• Other

LAHPSTR Alum? *

• Yes
• No

Male or Female? *

• Male
• Female

Neutered or Spayed? *

• Yes
• No

How long owned? *

Where kept? *

Pet 2

Name *

Type of Pet *

• Dog
• Cat
• Other

LAHPSTR Alum? *

• Yes
• No

Male or Female? *

• Male
• Female

Neutered or Spayed? *

• Yes
• No

How long owned? *

Where kept? *

Additional Pets (# - Name - Type - Alum - Male/Female - Neutered/Spayed - How long owned - Where kept). *

Immediate Household Members and Regular Visitors

Person 1

Name

First

Last

Age

Relationship to you

Lives with you?

• Yes
• No

Person 2

Name

First

Last

Age

Relationship to you

Lives with you?

• Yes
• No

Person 3

Name

First

Last

Age

Relationship to you

Lives with you?

• Yes
• No

Person 4

Name

First

Last

Age

Relationship to you

Lives with you?

• Yes
• No

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