Adoption Application
Name of Pet
Applicant Name
Name of Co-Applicant
Address
City and State
Zip
Home Phone
Cell Phone
work phone
Email Address
Best Number and Day/Time to Contact
Applicant Occupations and Work Schedules
Costs
Are you aware that routine costs to maintain a pet average $500 to $800 dollars a year? YES______NO_______
Household
Please list all members of the household excluding pets and ages of each: Name: Name: Name: Name: Name: Name
Pets in Household
Please list all pets in household.
Household Pets
Are all pets in the Household spayed and/or neutered? YES_____NO_______
If No, please indicate status of Pet.
Heartworm preventative
Are all dogs in your Household on year-round heartworm preventative? Yes_______NO______
Name of Preventative
What is the nameof the Heartworm preventative used? ____________________________
Pet Contacts
Other than children living in the Household, will your pet come in contact with other children under the age of 5 (i.e. neighbors, grandchildren)? YES______NO_______ If yes, What ages? ______ ______
Visitors
Do any elderly or physically challenged people live you or visit you frequently? YES_____NO______
Do you own or rent your home?
Rent
Own
Home/Landlord
If you rent, do you have your landlords permission to own a pet? YES____NO____ May we contact your landlord to verify permission? YES____NO____ Name of Landlord_____________________ Phone:______________________
Yard
Do you have a fenced yard? YES_____NO_____ Please describe fence (height, condition, etc)
Do you have a dog door?
Yes
No
Will this be your first Pet?
Yes
No
Pet History
What breeds of dogs have you been companion to?
Have you ever bred a pet?
Yes
No
Have you ever sold a pet?
Yes
No
Have you ever given a pet away?
Yes
No
Surrender
Have you ever surrendered a pet to a shelter? Yes_____No_____ If you answered yes to any of the preceding questions please explain circumstances:
Do all family members want a pet?
Yes
No
Don't know
Reasons
Please tell us the reason you want a pet.
Good Caregiver
Why do you think you would be a good caregiver to a pet?
Lifestyle
What age pet fits with your lifestyle and expectations?
Active Pet
Are you aware that some pets are very active? Yes________No_________
Activity
Do you have time and are physically able to give active pets adequate excercise? Yes______No_______
Shedding
Are you aware that all pets shed year round? Yes______No_____
Allergies
Is anyone in your home prone to allergies or may be adversely affected by a pet? Yes_____No_____
Family Activity
Describe activities that your pet would be included (i.e. swimming, camping, family outings)
Is anyone home during the day?
No
Yes
It varies
Alone Time
How long will the pet normally be left alone during the day?
Daytime
Where will the pet be kept during the day when no one is home?
When you travel with your pet, will they
ride in a car
ride in a truck-inside the cab
ride in a truck-outside cargo bay
Restraints
If you answered in a truck-outside, how will you restrain your pet to prevent accidents?
Will the pet be primarily kept
Indoors
Outdoors
Provisions
What provisions can you make for your pet if you become sick or hospitalized?
Life Changes
What will happen to the pet if you get married, divorced or have children?
food
What brand of Pet Food do you currently use?
Move
If you move, what will you do with your pet?
Crating
Are you familiar with the use of a dog crate to confine the pet during any absence, for their safety, as an aide in housebreaking or to provide a safe haven?
Nighttime
Where will your pet sleep at night?
Please check all that apply to pet:
Have the run of the house
Be in blocked off parts of house
Be crated
Be tied outside
Live in a fenced back yard
Live mainly in a dog run
Roam loose in the neighborhood
Cat
If you are adopting a cat, will the litter box be kept inside? Yes______No______
Will the cat be declawed?
No
Yes
Will the cat be allowed outside?
Yes
No
Laws
Loving Arms Pet Placement believes it is important to be aware of laws governing the ownership of a pet. Are you familiar with your local, county and state laws? Yes______No______
Home visit
May we visit your home prior to application approval? Yes_____No_____
Indicate best Time/Day for a Home visit
May we contact your Veterinarian?
No
Yes
Contact Information
If yes, Please provide: Name of most recent Veterinarian: ____________________________ Address:_____________________ Phone:______________________
How would you discipline your pet?
Ever had a pet with behavior issues?
Check all viable reasons to give pet up
Moving
Pet has fleas
Not using litter box
Shy/Not Friendly
Vet bills too expensive
Got too big
Having a baby
Barks too much
Digging/Chewing
How many years will you keep your pet?
Who is primarily responsible for pet?
How would you try to find a lost pet?
Destructive behavior
How would you deal with destructive behavior by your pet?
SYMPTOMS
How would you know if your pet became ill? What type of symptoms would you expect?
Time
Our volunteers may take up to two weeks to complete the adoption process, are you willing to wait? Yes_______No______
Donation
Loving Arms Pet Placement will require a $100.00($125.00 with microchip )donation if application is approved. Are you willing to pay this amount?
NOTICE-Must Read and Acknowledge
Answers are expected to be complete and truthful, as they will enable us to better comply with your requests and requirements. Failure to provide accurate information can result in revocation of the adoption at any time by Loving Arms Pet Placement. By completing this form the undersigned expressly give permission to Loving Arms Pet Placement to verify information contained in this application, and further release Loving Arms Pet Placement from any and all liability associated with this application or the adoption process. Agree_______
Terms and Conditions
I/We attest that the Terms and Conditions of Adoption, as stated above, have been read in full by Me/Us and I/We understand that these terms constitute a part of the adoption agreement between Me/Us and Loving Arms Pet Placement and will be enforced. Terms and Conditions have been read? Yes_______No______
Attestation
I/We attest that information provided on this application is true and accurate to the best of My/Our knowledge. I/We understand that completion and submission of this application does not guarantee adoption of a pet. If application is submitted electronically, I/We further attest that no changes have been made to the content of this document and understand that my approval by signature is assumed and agree to transmit a signed orginal or facsimile prior to any decision by Loving Arms Pet Placement on my Adoption application. Signature: ____________________________ Date________________________
Thank you
Thank you for your interest in providing a loving and permanent home to a Loving Arms Pet Placement Pet. Submission of an adoption application does not guarantee an adoption of a pet through Loving Arms Pet Placement. Thank you for opening your home and heart to a rescued pet.
Comments/Suggestions