Animal Adoption Application

Email address*

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Emergency Contact Name

First NameLast Name

Emergency Contact Phone

Area CodePhone Number

Verification*

I verify that I am 18 years of age or older, have identification showing my current address, and have knowledge and consent of my landlord. I understand falsification of information will lead to rejection of this application. I understand filling out an application does not reserve or hold an animal for me prior to adoption and that HES reserves the right to refuse adoption to anyone.

Are you interested in a specific pet that you have met at the LDB Farm and Animal Sanctuary or seen on our website? Please let us know who your top choices are.

What kind of pet are you interested in? Check all that apply.*

What size pet are you looking for?*

SmallMediumLarge

Why are you interested in adopting a pet? (check all that apply)*

What energy level are you looking for?*

High Energy (Daily vigorous exercise)Medium Energy (A daily walk)Low Energy (Couch buddy)Other

If a behavior cannot be tolerated or changed after adoption, what steps would you take?*

Return to shelterGive awayConsult a professional trainerOther

Do you currently have pets in the home? *

NoYes

If you do have pets in the home, please describe them below.

If you do have other pets, what kind of identification do they have?

How many people are in your household?*

What are the ages of the people in your household?*

Where do you live? *

HouseApartmentCondo/townhouseOther

Do you own or rent?*

Own my own homeRentLive with parents or homeownerOther

If you rent, is a pet deposit required?

YesNoDon't knowOther

If you rent, provide the name and phone number of your landlord. If you live with your parents or the homeowner, please provide their name and phone number. *Required if you do not own your home*

What are your plans for your pet when you are NOT at home? Please describe in detail. *

What are your plans for your pet when you are AT HOME and AT NIGHT? Please describe in detail. *

Do you have a fully fenced yard?*

YesNoOther

Tell us about your past experience with pets. *

How long did you have previous pets and why are they no longer with you?*

Do you have a regular veterinarian?*

YesNoOther

If so, which veterinarian?

Are all pets you currently have up to date on annual vaccines?

YesNoOther

Please tell us anything else you would like to share about you, your family, your lifestyle, your ideal pet, your past pets, or anything else.

By sending this electronically, I acknowledge that I have completely read 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 LDB Farm and Animal Sanctuary pet adoption 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 electronically, I agree to release and covenant to hold harmless LDB Farm and Animal Sanctuary and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted pet. I accept full responsibility for the pet(s) actions at all times, and release LDB Farm and Animal Sanctuary from any liabilities or damages that may be incurred because of adopted pet(s). I agree to have LDB Farm and Animal Sanctuary complete reference call checks and conduct a home visit inspection to be able to approve my adoption application. I agree that if I'm unable to care for the pet(s) anymore that I will return the pet(s) to LDB Farm and Animal Sanctuary and try to give LDB Farm and Animal Sanctuary a 2 week period to try and find another suitable adopter/foster for the pets).

337 Grandy Road Grandy NC 27939

Signature