Lil' Rascals Refuge Adoption Application

Adoption Application

Incomplete Applications will not be processed. Filling out this applicaiton does not guarentee adoption and we have the right to refuse any client for any reason at any time.
Lil' Rascals Refuge Inc.

P.O Box 234

Thorp, WI 54771

1 715 271 0699

lilrascalsrefuge@yahoo.com

wearelilrascalsrefuge.weebly.com
Animal of Interest
If you are looking at a specific breed have you researched this breed or have experience?*
Name of applicant*
Birth Date*

MonthDayYear
Occupation*
Name of Spouse/Signicant Other-
Occupation
Number of Adults living in the household*
Number of Children living in the household and Ages
Are all members of the family in agreement to adopt?*
If not, why?
Who will be the primary caregiver for this animal?*
Are there any breed bans/laws in your city/town that you are aware of?*
Street Address*
City*
State*
Zip Code*
Home Phone
Work Phone
Cell Phone*
Email Address
Preferred Way of Contact*
Do you live in a *

HouseCondoTownhouseTrailer HomeApartmentOther
Do you *

OwnRentOther
If you rent, do you have your landlords permission to have a pet?*

YesNoNot Applicable
If you OWN please put N/A to Landlords Name/Number
Landlords Name *
Landlords Number*
How long have you lived at your current residence?*
Do you smoke inside your home?

YesNo
Any plans of moving in the near future?*
How many times have you moved in the past 5 years?*
How will your new pet be taken outside to play or use the bathroom? Example: Fenced yard, dog park, tie out ect.*
How much of the time will the animal be outdoors?*
How much of the time will the animal be indoors?*
On average how many hours a day will your pet be alone?*
Where will the pet be kept when you are not home?*
Do you plan on taking your new pet to daycare, having a dog walker or family member attend to the dog while not home?

YesNoMaybe
What area(s) of the house will your new pet be allowed?*
Where will your new pet sleep at night?*
Do you have a fenced yard?*

YesNo
If so, how high is the fence?
Type of fence?
Are the gates normally locked?
Do you have a pool?

YesNo
If so, is it fenced seperately from the yard?
Why are you looking to get a new pet?*
Why do you want a pet?*

House petCompanion for other petProtection for home/familyWatchdogCompanion for familyCompanion for childrenProtection for businessFor giftOther
What brand or type of food are you planning to feed your new pet?
About your current pets:
Name, Age, Breed/Species, Gender, Spayed/Neutered?, Up-to-date on Vaccinations?, How long have you had this pet? Where did you aquire this pet?
Name, Age, Breed/Species, Gender, Spayed/Neutered?, Up-to-date on Vaccinations?, How long have you had this pet? Where did you aquire this pet?
Name, Age, Breed/Species, Gender, Spayed/Neutered?, Up-to-date on Vaccinations?, How long have you had this pet? Where did you aquire this pet?
Name, Age, Breed/Species, Gender, Spayed/Neutered?, Up-to-date on Vaccinations?, How long have you had this pet? Where did you aquire this pet?
If you currently have more than 4 pets please list the rest
If you have a cat, does it get along with dogs?*
If you have a cat, is it declawed/do you plan on declawing?*
If you have a dog, does it get along with other dogs?*
Are you experiencing any health/behavioral issues with your current pet? If so, please explain*
Past Pet History
Have you ever given a pet away, surrendered it to a shelter/rescue group, returned it to a breeder or sold it?*
If so, please explain
Have you ever given up a pet after having it a short period of time?*
If so, please explain
Have you ever had a pet lost or stolen?*
If so, please explain
Have you ever had an animal die from being hit by a car, poisned or another unknown cause?*
If so, please explain
Have you ever had to retrieve your animal from a shelter or animal control facility?*
If so, please explain
Have you had a dog/cat that has given birth while in your care?*
If so, please explain
Have you previously applied to adopt from LRR?*
Have you ever adopted from LRR?*
Pets owned in the past 5 years that are no longer with you
Name, Breed/Species, Spayed/Neutered, How long did you have the pet for? Where did you aquire the pet? What happened to the pet that it is no longer with you?
Name, Breed/Species, Spayed/Neutered, How long did you have the pet for? Where did you aquire the pet? What happened to the pet that it is no longer with you?
Name, Breed/Species, Spayed/Neutered, How long did you have the pet for? Where did you aquire the pet? What happened to the pet that it is no longer with you?
Name, Breed/Species, Spayed/Neutered, How long did you have the pet for? Where did you aquire the pet? What happened to the pet that it is no longer with you?
If you have had more than 4 pets in the past 5 years that are no longer with you please explain:
Have you ever had to euthenize a pet in the past? If so, why?*
What would happen to the animal if you moved: Locally, Out of state or out of the country?*
Do you have a regular veterinarian?*
Name of Clinic*
Name of Vet
Address
Phone Number*
May we use this vet as a reference?*

YesNoNot Applicable
Are you aware some new pets may take time to adjust to a new home, family/enviornment and other pets?*
Are you willing to allow this adjustment period?*
Are you willing to bring your new pet to annual veterinary exams and vaccinations per your veterinarians reccomendations?*
What circumstances might justify you giving up your pet?*

BabyMovingSheddingDivorceAllergiesBehavior ProblemsDog Becomes IllChildren Lost InterestNot getting along with other petsHousehold member dislikes new petNot HousetrainedDestructiveToo time consumingNoneOther
Are you willing to pay for training classes for your new pet?*
Do you plan on taking your new pet to training classes?*

YesNo
If not, please explain.*
How would you train your new pet?*

Obedience SchoolFirm Verbal CommandsHit with newspaperClicker/Hand SignalPositive ReinforcementOther
Are you able to commit to potty training, training or taking time and having patience to work with this animal if needed?*
Bad habits from your new pet you would not tolerate*
If your new pet exhibits behavioral or adjustment issues are you willing to seek the advice from a LRR consultant or professional?*
Preferences
I prefer a dog that is:*

smallmediumlargeany size
Energy Level Preferred:*

LowMediumHigh
I intend to (check all that apply)*

Walk pet on a leashBring dog to a dog parkHunt with the dogWalk dog off leashGo jogging or hiking with the dog
I prefer a dog that is (check all that apply)*

PuppyAdultSeniorMaleFemaleIndoorOutdoorIndoor/OutdoorActiveMellowPlayfulLap dogHousetrainedDoes not shed
How do you plan to exercise your new pet?*
Do you want/care if your new pet is 'purebred'?*
If so, please explain
Breeds/Mixes you may be interested in adopting*
Will you be able to live with hair on your furniture, stains on your rug, a warm body on your bed and an animal that might be destructive at times?*

YesNo
Are you able to make a long term commitment to care for your pet for its entire life span, which could be as much as 10-20 years?*

YesNo
Remember, pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, proper shelter and excercise for your new pet?*

YesNo
Under what circumstaces would you not be able to keep your new pet?*
If there were an emergency or something happened to you do you have arrangements for your pet?*
If you are no longer able to keep your pet are you willing to return he/she back to LRR?*
Does anyone in your household have allergies?*

YesNo
If so, what kind?
Are you able to come meet the animal you are interested in?*

YesNo
List 2 references. At least ONE non family.
Reference 1: Name, phone number and relationship*
Reference 2: Name, phone number and relationship*
Are there any special needs or circumstances we should consider?*
Are you willing to allow LRR to do a home visit before or after you adopt?*

YesNo
At any time for any reason it is not working out with your new pet are you willing to contact LRR?*

YesNo
Are you willing to keep in contact with LRR after adopting?*

YesNo
Have you read our adoption policies and procedures?*

YesNo
If you have NOT read our adoption policies and procedures please read it here:

http://wearelilrascalsrefuge.weebly.com/adopt.html
Have you ever been convicted of a crime against animals?*
How did you learn of our rescue organization? (Check all that apply)*

FacebookFriend/FamilyAdoption EventNewpaper/Magazine ArticleAdopt-A-PetOther
Application Fee

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USDApplication Fee
Lil' Rascals Refuge reserves the right to refuse adoption to any client for any reason. This questionaire becomes part of our contract.
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About your current pets:

Lil' Rascals Refuge reserves the right to refuse adoption to any client for any reason. This questionaire becomes part of our contract.