TLC Rescue: Dog Adoption Application

Name of the dog you want to adopt*

Adopter's Name*

First & Last Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Adopter's E-mail*

Phone Number*

Area CodePhone Number

Phone Type*

CellHomeWork

Names and ages of all permanent residents of your home (adults/children)*

Do you currently have any pets?*

YesNo

If you currently have pets, please list them below.

Are your current pets altered?

YesNoWill be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)

Two Personal References*

Are you planning to move in the near future?*

YesNo

Is anyone in your home allergic to dogs?*

YesNo

Does anyone in your home fear dogs?*

YesNo

I/We live in a*

Do you rent or own this property?*

RentOwn

Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

YesNoNot yet, but I willIt's written in our lease

Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)

Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts

How many hours per day will this dog be alone? Please explain.*

Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.

How do you plan to integrate this dog into your family?*

Do you plan to take formal obedience classes?*

YesNo

Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*

I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help LPD Rescue determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I as the adopter agree that I will not sell, give away or otherwise dispose of said animal to any person(s), dealer, retailer, auction, institute or any other entity for any reason. If at a later date I am unable or unwilling to keep this pet, I agree to first contact LPDR and give them the option to reclaim said pet at no charge.

I hereby agree to care for the above described pet in a humane and responsible manner and to provide it with clean and adequate shelter, food, water and veterinary care and am able to provide and keep the following information up to date with LPDR.

I further agree that said pet shall reside inside my home and shall not be allowed to roam freely, be chained and/or kept outside for a period of time longer than 24 consecutive hours. I hereby agree that this pet shall wear a collar or harness with identification tags at all times.

I hereby agree that the adoption fee helps to cover LPDR expenses of raising and caring for the animal and I have been notified this fee and is nonrefundable for any reason. The adoption of the said animal above can vary with description of breed and date of birth. LPDR will be relieved of all financial and legal responsibility of the animal once this contract is executed.

I understand and agree that LPDR makes no representations or warranties, expressed or implied, about the above mentioned.

I understand the animal's temperament and is hereby absolved from any liability for future damages or injuries caused by said animal. I also understand and agree that LPDR further gives no guarantees, expressed or implied, of the suitability of the animal to the adopter and/or his family.

I certify that all statements made by me on this adoption agreement are true and correct. I agree that LPDR has the right to confiscate the above described animal in the event that any statements made by me are found to be false and/or I have violated this agreement in part or in its entirety. Any and all legal fees, court costs, arbitration fees or any monetary harm brought on by the adopter to LPDRwill be at the sole responsibility of the Adopter.

Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.

Applicant's Signature*

Signature date*

Lucky Paw Rescue