Adoption Application - Louisiana Dog Rescue

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Louisiana Dog Rescue

Adoption Application

PLEASE READ: By signing this application, you authorize Louisiana Dog Rescue to contact your veterinarian and/or conduct a home visit. Adopters must meet certain criteria to adopt and Louisiana Dog Rescue reserves the right to deny any potential adopter if they do not meet certain criteria.

* Indicates required field

Name of Pet *

Name *

First

Last

Spouse/Partner's name *

First

Last

Cell Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Date of Birth *

Spouse/Partenr's Date of Birth *

Place of employment *

Why have you decided to adopt a pet? *

Personal Companion Family Pet Protection Pet Companion

Do all members of your household support the decision to adopt a pet? *

Yes No

Number of adults living in household *

Ages of adults living in household *

Number of children living in household *

Ages of children living in household *

Does anyone in your household have allergies to animals? *

Yes No

If yes, how will this be managed? *

Do you have a fenced in yard? *

Yes No

If yes, what type and how tall and if no, how will your pet be restrained outdoors? *

Do you have a pool? *

Yes No

Do you: *

Own home Rent home Rent apartment Own condo Rent condo Live in mobile home park Live with a roomate

If renting, does your landlord allow animals? *

Yes No

Landlord's name and phone number *

Are you planning on moving in the near future? *

Yes No

If yes, where? *

How many animals do you currently have? *

How many dogs? *

Other pets (how many and what type?) *

How may cats? *

Are your pets spayed and neutered? *

Yes No

Are all of your pets UTD on vaccinations? *

Yes No

If not, please explain why *

Do your current pets wear ID tags and/or microchipped? *

ID tags Microchipped None

Do your current pets get along with new dogs? *

Yes No Not sure

Have you ever surrendered a pet to an animal shelter and/or rescue? *

Yes No

If yes, please explain why *

Have you ever given a pet away? *

Yes No

If yes, please explain why *

Current and past pets (please list the type of pet, length of time you have had them, and what happened to them if they are no longer with you) *

Where will the pet spend most of their time? *

Indoors Outdoors

Where do you plan to have your new pet sleep? *

How many hours a day will this pet spend alone? *

How will you confine this animal when you are not home? *

What would you do if you could no longer care for this pet? *

Under what conditions could you no longer keep this pet? *

How do you disipline your pets? *

Is this pet a gift? *

Yes No

Are the dogs you have now (or past dogs) on heartworm prevention? *

Yes No

If yes, what brand and how often do they receive heartworm prevention? *

If you own a pickup truck, will you let the dog travel in the back? *

Yes No

Are you ok with a home visit prior to adoption? *

Yes No

Have you thought about how a pet will effect your life during times of stress, unemployment, marriage, birth, divorce, moving, and other events? *

Where would the dog stay if you went on vacation? *

Are you committed to potty training if needed? *

Have you thought about how a pet will effect your daily life? *

Have you ever applied to adopt before? *

Yes No

Were you approved? *

Yes No N/A

If yes, what rescue or shelter? *

Veternarian's Name/Clinic *

Veternarian's City, State *

Veternarian's phone number *

Submit

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