Little Orphan Angels Dog Adoption Application

In order to be considered for an adoption today you must:

1.     Be 21 years or older.

2.     Have identification showing your present address.

3.     Have the knowledge and consent of all adults living in your household.

4.     Be able and willing to spend the time and money necessary to provide the training, medical treatment, and proper care for your dog.

5.     For the adopted dog, have the cash to pay an adoption fee (LOA accepts checks with a valid Texas Driver’s license).

6.     Understand that LOA has the right to deny or approve your application; understand that this application will be retained in our files.

 

Animal's Name:
Your Name:
Address:
City:
State:					Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota North West Territory Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Is. Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Home Phone:
Place of employment:
Work Phone:
Cell Phone:
Age:
Email Address:
Do you own or rent your home?					Own Rent
If renting, do you have your landlord's permission to keep a pet?					Yes No
Landlord's Name:
Landlord Phone:
If renting, have you paid your pet deposit?					Yes No
How long have you lived at this address?
If less than 1 year, please state how long at previous address.
How many adults in household?
How many children?
Age(s) of children living in your home?
Is anyone allergic to pets in your house?					Yes No
Do you have a fenced yard?  If so, what type?					Yes No  Type: chain link 4' wood 6' wood 8' wood ranch style other
What type of dog do you wish to adopt?  (Age, breed, sex, personality)
Do you realize that dogs often live longer than 10 years and are you willing to accept responsibility for that long?					Yes No
What made you decide you wanted to adopt a dog today and how long have you been looking?
How did you find Little Orphan Angels?					PetFinder.com Vet referral Previous Adopter PetsMart
Can you keep your new dog isolated from existing pets for at least a week?					Yes No
Do you realize you will probably have to housetrain your new puppy or dog?					Yes No
What percentage of the time will your dog be indoors?					100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside
Where will the dog stay when you are at work or away from home?
Where will the dog sleep at night?
Do you have a dog or cat door?					No Yes  to where:
Will there be any regular extended periods of time your dog will be alone?					Yes No   if yes, please describe what arrangements will be made for the dog's regular and emergency care:
Under what circumstances would you give up your pets?
What would you do if your pet shows destructive behavior?
Who will be responsible for your dog?
Do you want to have your dog spayed or neutered?					Yes No
Are you willing to take your dog to obedience training?					Yes No
Who is your current Veterinarian/Clinic:
Veterinarian Telephone:
What brand & type of food do you intend to feed your dog?
Are you familiar with the following diseases?					Heartworm Disease Corona Virus Distemper/Parvo Kennel Cough
Are your current dogs on heartworm preventative? What brand?
Are any dogs in your household diagnosed with any of the above diseases?					Yes No   if yes, please describe:
Have you ever adopted a dog before? If so where from?					Yes No
Have you ever given up an animal for adoption?  If yes, why and what arrangements did you make?					Yes No
Number of pets currently owned:					Dogs:      Cats: Others:
Please list details for all of your currently owned pets:
Cat/Dog	Breed	Age	Sex	Length of Ownership	Vaccination Due Date	Neutered	If not neutered why not?	Percentage of time kept indoors
Cat Dog OTH Cat Dog OTH Cat Dog OTH Cat Dog OTH Cat Dog OTH			M F M F M F M F M F			Y N Y N Y N Y N Y N		100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside
Please list details for all of your previously owned pets:
Cat/Dog	Breed	Age	Sex	Length of Ownership	What became of this pet?	Neutered	If not neutered why not?	Percentage of time kept indoors
Cat Dog OTH Cat Dog OTH Cat Dog OTH Cat Dog OTH Cat Dog OTH			M F M F M F M F M F			Y N Y N Y N Y N Y N		100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside 100% of the time 90% of the time 75% of the time 50% of the time 25% of the time Totally Outside

I certify that the above information is true and that false information may result in nullifying this adoption. I also authorize my veterinarian to release my veterinary records on my personal pets.

Little Orphan Angels Animal Rescue & Adoption Agency

1205 N. Saginaw Blvd #D, PMB 205, Saginaw, TX 76179 

(817) 741-2386 ۰ Fax: (817) 741-2385

A  nonprofit, tax-exempt organization

©Copy Right Little Orphan Angels Animal Rescue & Adoption Agency 2010