First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Cell Phone

Pet's Name*
Choose an animal: Freddy Winston

What about this particular pet sparks your interest?

Tell us what you know about this particular breed or what you hope this breed can do for you?

Name(s)*

Reference #1 - Please list the full name of a personal or professional reference. *Do NOT list a family member.**

Email address (REQUIRED)*

Reference #1 - What is your relationship to this person?*

Reference #2 - Please list the full name of a personal or professional reference. *Do NOT list a family member.**

Email address (REQUIRED)*

Reference #2 - What is your relationship to this person?*

Do you own or rent your residence?*
Choose one: Own Rent

Setting*
Choose one: Rural Suburban Urban

Type of Home*
Choose one: Single-Family Apartment Townhouse Mobile Home Duplex Condominium

If you rent, are pets permitted on your lease, and if so, what is the weight limit?*

Landlord's name:

Landlord’s phone number

Do you have a fenced yard?*
Choose one: Yes No

Describe fenced area (size, height, type of fencing, flooring)

How many adults are in your household*

How many children are in your household*

If you have children in your household, what are their ages?

Is everyone residing in the house aware of & agreeable to your interest in adopting?*
Choose one: Yes No

Does anyone have animal allergies?*
Choose one: Yes No

If yes, who has the allergies?

What do you plan to do to avoid allergic reactions?

What plans do you have for training/disciplining?*

How many hours will this animal be alone (without humans) during the day?*

Where will the pet sleep?*

Where will the animal be when you are not at home?*

What will you do with the animal if you move?*

If you decide you no longer want the pet, what will you do with him/her?*

Have you considered any health problems or risks you may be exposing your current pet(s) to?*
Choose one: Yes No

Will you allow volunteers to investigate and/or inquire concerning the pet's circumstances?*
Choose one: Yes No

Have you ever released an animal to an animal shelter, given away, or sold an animal?*
Choose one: Yes No

If you have given an animal away, what were the circumstances?

How did you find out about us?*

Are you aware of the required adoption fee?*
Choose one: Yes No

We require a cash (PayPal, postal money order or certified/cashier's check) adoption fee if you are approved to adopt a pet through LFSAR. Do you understand donations are NOT refundable?*
Choose one: Yes No

Are you aware of the contractual requirements that adoption entails?*
Choose one: Yes No

If you adopt a cat, do you plan to declaw?
Choose one: Yes No

If you adopt a cat, will he/she be confined to the indoors?
Choose one: Yes No

If you adopt a cat, and you become pregnant, who will change the litter box?

If you adopt a dog, will you keep him/her on heartworm preventative forever?
Choose one: Yes No

If you adopt a dog, do you own an appropriately sized crate or are you willing to purchase one?
Choose one: Yes No

If you adopt a dog, what will you do if he (male dogs only) marks his territory in the house?

If you adopt a dog, what would you do if the dog ate a hole in furniture or chewed up something valuable?

If you adopt a dog, what would you do if it had a potty mess in the house?

Veterinarian (present or former, no matter where located):

Vet's Phone

May we call your vet for a reference?
Choose one: Yes No

What type of heartworm preventative do you use?

Please list ALL pets living in your household to include description (type name, breed, sex, age) (List any that won't fit here under "Comments.")*

How long have you had these pets?*

Are these pets neutered or spayed?*
Choose one: Yes No

If any of these pets are not fixed, please provide the reason.*

PREVIOUS Pets - Description (type name, breed, sex, age) (Go back only 5 years. List up to 3 here. List additional pets under "Comments."):*

How long did you had these pets?*

Were these pets neutered or spayed?*
Choose one: Yes No

If these pets were not fixed, please provide the reason*

We recommend the adopted dog graduate from an obedience program. Will you be willing to do this?*

Please let us know any other information you wish us to consider in placing a pet with you. Here is your chance to personalize this application.

By indicating yes and submitting this form, I signify that all information given in this application is true and correct, to the best of my/our knowledge.*
Choose one: Yes No

How did you hear about us?