Adoption Application

ADOPTION APPLICATION

Applicants outside of Texas
Please fill out COMPLETELY. If the item has an asterisk (*) next to it, that means it is required to be filled out for the application to be submitted.

Cypress Lucky Mutt Rescue is an all-volunteer run organization. We will only contact applicants we are screening for a respective dog.

We reserve the right to refuse adoption to anyone for any reason. No animal will be adopted to a person who fails to provide complete and accurate information on this application.

If the dog applied for is no longer available, we will hold your application and you can email us when you see another dog that interests you. We strive to work with applicants that are committed to our process and do our best to find the right match.

YOU MUST BE AT LEAST 21 YEARS OF AGE TO ADOPT.

Adopter Information
Name of the animal you are applying to adopt*
Your Name*

First NameLast Name
Name on Facebook if different from above?
This helps us associate messages with your application.
Your Date of Birth*
You must be 21 or older to adopt
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone Number*
Home Phone Number
Work Phone Number
Occupation
Type of dwelling*

HouseApartmentCondoTownhomeMobile HomeOther
Do you own or rent?*

OwnRent
If renting, does your lease allow pets?

YesNo
Breed or weight restrictions?
Is a pet deposit required?

YesNo
Pet deposit amount?
Has a pet deposit been paid?

YesNoOther
Landlord or Complex Name
Landlord or complex phone number
Number of adults*
Number of children*
Ages of children*
i.e., 3, 5, 10 (N/A if not applicable)
Does every adult in the household agree to adopting this pet?*

YesNo
Does anyone in the household have known allergies to animal dander?*

YesNo
If Yes, please specify
Have you adopted a rescue animal before?*

YesNo
If yes, what organization or shelter?
Please give a personal reference who we may contact (name and phone number)*
What is your relationship to the person above?*
Current Animal Information
How many pets do you currently have? Please list all on the following chart. (Please scroll to the far right to complete the chart.)

	Pet Name	Species	Breed	Sex	Age	Spay/Neutered	Kept Where
1
2
3
4
5

Do you free feed any of your animals?*

YesNo / don't know what that is
What veterinarian do you or will you use?*
Enter "NONE" if you do not currently have a veterinarian
What is your veterinarian's phone number with area code?*
Have you called your veterinarian to consent to them to release information to a Cypress Lucky Mutt Rescue representative?*

YesNo
Are your animals current on all vaccines?*

YesNoN/A
Is your current dog OR was your previous dog on heartworm preventatives?*

YesNoN/A
What type of heartworm preventatives?*
Have you had any other pets in the last 5 years?*

YesNo
If yes, please indicate what happened to them and where they are now.
Have you ever given up a pet?*

YesNo
If yes, please explain.
Adopting Animal Information
Why do you want to adopt a dog?*
What traits/qualities are you looking for in a dog?*
What traits or characteristics are you sure that you DO NOT want? Please be specific with regards to size, activity level and coat.
How will you correct your dog if they engage in inappropriate behavior?*
Where will the pet be kept during the DAY as a PUPPY?*

Loose IndoorsPen/CrateClosed in a roomFenced YardLoose outsideOther
Where will the pet be kept during the NIGHT as a PUPPY?*

Loose IndoorsPen/CrateClosed in a roomFenced YardLoose outsideOther
Where will the pet be kept during the DAY as an ADULT?*

Loose IndoorsPen/CrateClosed in a roomFenced YardLoose outsideOther
Where will the pet be kept during the NIGHT as an ADULT?*

Loose IndoorsPen/CrateClosed in a roomFenced YardLoose outsideOther
On a typical day, how many hours will this pet be left alone with no one home?*
Do you or your spouse/partner travel frequently?

YesNo
Is so, how often?
What will you do with the pet when you travel?
What will you do with the pet if you have to move?*
When outdoors, how will the dog be confined to your property?*

Fenced yardKennel/RunChained/TiedAllowed to roam free in the neighborhoodOther
Type and height of fence.*
If your pet was lost, what would you do?
How will you exercise the dog?*
Most puppies and many of our adult dogs will NOT have been housetrained. Please describe the method you will intend to use to housetrain your new pet?
Please tell us what you know about crate training.
We recommend that you take your new dog to obedience training, especially if you are a first time dog owner. How much would you be willing to include in your budget for training?
Do you understand that puppies go through a chewing stage and in some breeds this can last up to 2 years?

YesNo
During the chewing phase, it is VERY important to have plenty of toys on hand and secure your shoes, children's toys, electrical cords, etc. Are you willing to commit to doing this?

YesNo
Please tell us what you know about heartworm and heartworm preventative treatments.*
What costs do you expect to incur in having this pet?
If you adopt an intact puppy, you understand that they are required to be spayed/neutered at 6 months of age, you are responsible for the cost of the surgery. You must provide CLMR with a copy of the spay/neuter certificate after the surgery.*

I agree
Dogs often live 10+ years. Are you prepared to make this commitment?*

YesNo
Should you have an unexpected illness, emergency hospitalization, or death who will be responsible for the care of the dog?
Is this dog for someone else?*

YesNo
If yes, please explain.
Terms & Conditions
I certify that the above information is true and correct. I understand that false information may result in nullifying this application. Cypress Lucky Mutt Rescue reserves the right to deny any adoption application.
Signature of applicant
(By typing your name in this box you understand it is to be used as a legal signature)
Date*

MonthDayYear
Date
Should be Empty:

ADOPTION APPLICATION

Adopter Information

Current Animal Information

Adopting Animal Information

Terms & Conditions