LAR Adoption Application

Leann’s Animal Rescue is an all-volunteer animal welfare organization dedicated to the rescue and placement of stray, neglected, and abused animals. The rescue is funded primarily by the founding member, as well as through fundraising efforts and public donations. All of the pets have been cared for by the founding member, or a well trusted foster parent. All pets will receive necessary medical care prior to adoption, which includes worming, vaccinations, spaying/neutering, and whatever else may be required.

This questionnaire is designed to help Leann’s Animal Rescue and yourself if a specific animal is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Leann’s Animal Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoption.

How did you hear about Leann's Animal Rescue?*

Name of animal you are interested in:*

Are you aware that there will be an adoption fee associated with the animal you are applying to adopt? Are you prepared to make the adoption fee payment, in full, prior to finalizing the adoption and taking the dog home?*

YesNo

Full Name:*

Age:*

Email:*

example@example.com

Phone Number:*

Home Address:*

Do you live in a:*

HouseApartment

Do you own or rent your home?*

OwnRent

If renting, please provide landlord contact information:*

Does your landlord allow dogs? Prior to completion of adoption, a written consent form will be required.*

YesNo

Are there any restrictions from your landlord or subdivision? (select all that apply)*

Number of petsSize or weight restricitionsBreed restrictionsNone

Describe your home's activity level:*

Busy/noisyModerate comings/goingsQuiet with occasional guests

What length of time will you allow your new pet to adjust to his new home?*

Are you willing to work through your new pet's issues, if any?*

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo

Do you understand that a dog or cat can be an 18+ year commitment, and can cost on average $300-$500 per year to care for?*

YesNo

Please list all people living in the household, their relationship to you, age, and gender:*

Does anyone in your household have allergies to animals?*

YesNo

Are all members of your household agreeable to adopting an animal?*

YesNo

Who will be the pet's primary caregiver?*

Please list all pets living in the household, their name, breed, age, and gender, as well as if they are spayed/neutered and up to date on all vaccines:*

Do you have a preference of species you would like to adopt?*

DogCatNo preference

Do you have a preference of gender you would like to adopt?*

MaleFemaleNo preference

Are you willing to adopt an animal of any age?*

YesNo

If no, what age would you consider?*

What size dog are you willing to adopt? (select all that apply)*

SmallMediumLarge

Please describe the type of dog you are willing to adopt (including coat length, personality traits, energy level, etc):*

Are you willing and able to take your new pet to vet appointments?*

YesNo

Are you willing and able to give your new pet any medications?*

YesNo

Are you equipped to train with love and patience (this includes potty training)?*

YesNo

Have you had an prior experience with an emotionally/physically neglected/abused dog?*

YesNo

If yes, please explain:*

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a fenced in yard?*

YesNoPartial

If fenced, please give details on height, material, # of gates, and if the gates are locked/lockable:*

How many hours in a day would your new pet be left alone?*

Where will your new pet stay when nobody is home?*

What are your plans to exercise your new pet? How many walks a day, length, and activities, etc:*

Where will your pet sleep at night?*

Please list 3 personal references, their relationship to you, and their phone number:*

If under any circumstances you were unable to keep your new pet, Leann’s Animal Rescue requires that you agree that the animal will be returned directly to the rescue and will not be rehomed to another party, unless prior written consent is received from Leann’s Animal Rescue. If the animal is returned to Leann’s Animal Rescue, the adoption fee will be non-refundable.

Do you agree to these terms?*

YesNo

By signing this application, I acknowledge that I have completely read the policies, procedures, and this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Leann’s Animal Rescue animal adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form, I agree to hold harmless Leann’s Animal Rescue and its members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted animal.

I accept full responsibility for the animal’s actions at all times, and release Leann’s Animal Rescue from any liabilities or damages that may be incurred because of adopting such animals.

I agree to have Leann's Animal Rescue complete reference call checks and conduct a home visit inspection to be able to approve my adoption application.

I understand that I assume full responsibility for the welfare of this pet from the date of the adoption.

Printed Name*

Applicant Signature*

Date*

Date