Lost Love Animal Rescue - Adoption Application

Your name:
Address:
City:		State:
Zip:	Phone:
Email address:

 

Name of pet you are applying for:

Why are you interested in this particular breed/animal? 

Is this your first experience with a pet? Yes  No

List pets you currently have in your household:

Name	Type	Altered?	Kept Where?	Age
		YN
		YN
		YN
		YN

List pets owned in the last five years not listed above:

Name	Type	Altered?	Kept where	Age	What happened to pet?
		YN
		YN
		YN
		YN

 

Who is your Veterinarian? Phone:

Do you currently live in a ? House Condo Apartment Mobile home Duplex

Do you? Own Rent

If you rent, does your lease allow pets? - Yes No

If yes, what is the name of your landlord? Phone:

How long have you lived at your present address?

How many people live in your household?

Do all the adults know you plan to adopt a pet? Yes No

Number of children and their ages?

Does anyone have any pet allergies? Yes No

If yes, what type?

Who will be responsible for care of the pet?

Where will it be kept during the day?

Where will it be kept at night?

How many hours will the pet be left alone?

Do you have a fenced yard? Yes No

Type of fence? - Wood Cyclone Farm fence Invisible How high?

Are you familiar with crating? Yes No

If yes, what are your feelings about crates? 

Do you plan on attending obedience classes? Yes No

Are you familiar with heartworm disease? Yes No

How will your dog be confined to your property? (check all that apply)
House Kennel Fenced yard Chain Garage Patio Leash

How will your pet be cared for while on vacation?

Do you plan on adding another pet to your household after this adoption? Yes No

Please explain: 

Are you a student or other temporary resident?Yes No

If yes, when you move, will your situation allow you to take your pet with you?

Do you have plans to move in the next 12 months?Yes No

If yes, please explain

Why are you wanting to adopt at this time? (for example... companion for pet, mouser, guard dog, etc.)

Is this pet a gift?Yes No

If yes, please explain

Do you prefer clawed or declawed? (Answer only if you are interested in adopting a cat)Clawed Declawed

Do you currently have a cat/dog door?Yes No

If yes, to which area does this give your pet access?

How did you hear about us? Web search Petfinder search Flyer Newspaper ad Word of mouth Other

Please list three personal references:

Name	Phone	Relationship

Employer's name: Phone:
City: Normal amount of hours worked (per day):

 

Click Submit to send the form results to us.
Thank You