LYR Adoption/Foster Application

Adoption/Foster Application
Thank you for your interest, Please continue. Be sure to fill out the entire application. All questions marked with a ( * ) are required and they must be answered. If they are not, the application will not submit. If any of those marked required do not pertain to you, mark (N/A) in order to move forward with the application process. Ater answering all of the questions, send your applicatin fee using the ling below and then submit your application.
Which Rescue or Rescues are you interested in Adopting? (Name/'s) *
First & Second Choices
If unavailable what would your Adoption/Foster Preference be? (Check all that apply) *

Female Male Either Male/Female Younger Older Any age
Check each option that you are interested in. *

Adoption Only Becoming a Foster to Adopt Foster Short term Foster Long term Get Pre-Approved Be put on a waiting list
Are you willing to work with us to correct any possible behavior issues that the rescue may have? *

Yes No To a point Yes, Short term
Do you have a trainer that you would use if needed? Yes / No (If Yes / Provide Information) *
Adopter Personal Information
Name *

First Name Last Name
Date of Birth? *
Email *
example@example.com
Address *

Street Address

Street Address Line 2

City State

Zip Code
Contact Number *

Area Code Phone Number
Employer (Company & Position) *
Work Phone;

Area Code Phone Number
Yourself & Family
Family: List the Names & Ages of any additional (Adult) family members or those who live in your home. *
Children: List the Names & Ages and Relationship to you of any (Children) under the age of #18 who live with you or who visit your home on a regular basis. *
List the Employers, Occupations & Hours of Everyone who lives in your home? *
Home Environment
Do you Own or Rent your home? *

Own Rent Other
Choose which best describes your living situation. *

House Condo Apartment Modular Home
If a Rental, does your lease permit you to have animals? *

YES NO YES/ LIMITED
If living in an apartment / condo are there any restrictions on dog ownership or Breed? (Explain) *
Landlords Name;

First Name Last Name
Landlord's Phone #

Area Code Phone Number
Do you have a yard with a fenced in yard? *

YES NO
If Yes, Please describe in detail including the Type & Height of fence and any Security measures taken to prevent animals from escaping or being harmed by predictors. *
Please be specific with your description.
IF No, Please describe how you plan to exercise the rescue ?
Rescue Animal Living Space & Care

This is important information, Please be Specific.
How many hours per day will your Rescue be left alone? *

1 -2 2 -4 4 -6 6 - 8 8 - more None
Please describe in Detail what the Rescues living situation will be. (Please give a detailed description including hours when no one will be home.) *
Please be very Specific with your answer .
Current & Previous Pets

Including Vet Care
Have you had rescues previously? *

Yes No
If Yes, name, ages, breed? Describe: Where you got them, where they are now and if re homed why? *
Please be specific
Other animals living in your home? (Click all that apply) *

Dogs Cats Caged Animals None
Are your pets currently UTD on Vaccinations? *

Yes No Some not All
Are your pets on Heart-worm Preventative? *

Yes No Not right now They will be
Are your pets Spayed or Neutered? *

Yes No Not Yet Some not All
List ALL family Pets/ Include the Following: (Type / Breed / Age / Weight and Dates of last Vet. appointment & Vaccinations, Heart-worm, Flea meds. & Spay/Neuter dates) *
DO NOT EXCLUDE ANY OF THE INFORMATION REQUESTED
Have any of your pets Ever displayed any Food or other aggression's toward other animals or humans? *

Yes No
If so, Please give a detailed description. (Include: Date of any bite incidents) *
List all Previous pets that you've owned in the past 5 yrs. (Include: Years owned & where they are now. *
Vets & Personal References
Name & Address of Current Vet

Name

Street Address Line

City State

Zip Code
Phone Number

Area Code Phone Number
Fax Number

Area Code Phone Number
Name & Address of Previous Vet

Name

Street Address Line

City State

Zip Code
Phone Number

Area Code Phone Number
Fax Number

Area Code Phone Number
Name & Address of Groomer

Name

Street Address Line

City State

Zip Code
Phone Number

Area Code Phone Number
Provide #3 References: #2 Non-Related / #1 Other. (Include: How they know you). *
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By signing via electronicly I agree that all of the information that I have provided in this application is complete and correct. I understand that any false information I have provided will invalidate this and any future applications. I further declare that I am financially and physically able to care for a rescue animal. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my rescue animal. I understand and agree to get yearly dog tags and provide Little Yorkie Rescue with verifiction includilng the assigned number. I understand the requirements and grant permission for Home Checks at random, both prior to and following adoption. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, Little Yorkie Rescue reserves the right to either refuse adoption or to nullify the adoption and reclaim said rescue from my premises without reimbursement of the adoption fees. I release Little Yorkie Rescue from any liabilities I may incur from the adoption process or by the rescue while in my care.
Please sign below: *

Type your full name as entered above Clear
Date

Month Day Year
Date
Should be Empty:

Adoption/Foster Application

Adopter Personal Information

Yourself & Family

Home Environment

Rescue Animal Living Space & Care

Current & Previous Pets

Vets & Personal References

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