Providing false information on this form will result in an automatic denial and rejection of application.
Animal’s Name: / Animal’s Description:
Adopter’s Name:
Complete Address:
City: / State: / ZIP Code:
Home Phone: / Other: Cell:
Email Address:
Date of Birth: / Today’s Date:
Please Describe Your Living/Family Situation
Own Home Rent Home Rent Apartment Condo Townhouse Mobile Home Flat/Studio
Live with Parent(s): Share Home: Other (please describe):
How Long? Years: Months: Other:
If renting or leasing, does your Association or Landlord allow pets? Yes No
If yes, what breeds are restricted (if any)?
If yes, can you provide written proof or the name and number of a contact, if needed? Yes No
The yard is: No yard: Completely fenced in area: Partial fence: No fence:
The fence is: Invisible fence: Chain link/cyclone: Privacy: Outside kennel: Other:
Please Describe Yard/Area/Fence:
Would you be willing to install a physical or electronic fence?
If no fence, how do you plan on keeping your dog contained in the yard?
How many people live in your household? Adults: Children: Infants:
Ages of all people living in the home:
Is everyone in your home in agreement with regard to adopting a pet? Yes No
Does anyone in your home have medical or allergy conditions? Yes No
If yes, please describe:
Who will be the primary caretaker of your adopted pet?
Who will be responsible for caring for the pet during your absence?
About Your Current Pets
Please provide information on animals currently living in your home
Pet Name / Type/Breed / Age / How long have you had pet? / Spayed/ Neutered? / Current w/Vaccines? / Heartworm Preventative? / Pet live inside or outside?
About Your Past Pets
Please provide information about the pets you have owned in the past 10 years.
Pet Name / Type/Breed / Age / How long did you have pet? / Why is the pet no longer with you?
If pet passed, please explain how. / When was this? (month/year)
Were the above pets vetted (vaccinated, heartworm prevents, alter) as required by your vet?Yes No
Have you ever relinquished a pet to a shelter or another person? Yes No
If yes, why?
Current/Previous Vet Information
Please provide all names & phone numbers of veterinarians that you have used for all pets alive or recently deceased. If we cannot verify the veterinarian history of the animals currently in your home, your application will be automatically denied.
Please call the vets you list to give permission for release of information or this may delay our processing your application.
Pet Name / Vet name / Vet Phone number / City location of Vet
Do you give your permission for our representative to call your vet(s) to obtain pet history?Yes No
Please Provide the Following Information About the Care of Your Adopted Pet
Where will this pet be routinely living? Inside Outside
Other (please describe):
Are your pets allowed on the furniture?
Where will your pet sleep at night?
Separate room Garage Outside Crate Dog bed Your bed
Other:
How many hours a day/night will the pet be left alone (approximately)?
Please explain:
Where will the pet stay or be kept when you are not at home?
What will you do with the pet if you move? Be specific.
What arrangements have you made to care for the pet in the event you can no longer do so?
Be specific:
What behaviors would you be UNABLE to tolerate from an adopted pet? (check all that apply)
Potty Accidents Shedding Scratching on furniture Being on furniture
Awaking early Getting into garbage High energy/very active Low energy/less active
What methods do you plan on using to discourage unwanted behavior(s)? (check all that apply)
Yell at pet Remove problem Positive Reinforcement Other (please explain):
For what reason would you consider giving up the pet? Please answer this question honestly! Our goal is to place our pets into homes where they will stay FOREVER. As some pets are not meant to live in every situation, we need to know for what specific reasons you would relinquish this pet. Be specific:
Why have you chosen to adopt a pet? Be specific:
What reason do you want this pet?
House Pet Companion For a child Companion/another pet Hunting Mouser Watch dog Therapy Gift, for whom: Other, be specific:
Additional Information
What are your feelings on spaying or neutering animals?
Are you aware that a pet requires yearly vaccines/tests and the costs can be a minimum of $200? Yes No
Note: Once you factor in food, trips to the groomers, pet sitter or kennel stays while you are on vacation and other injuries, illness, the cost of owning a pet often times can be as much as $500 or more a year; per pet. Please consider this before making a decision to bring an animal into your home and family.
How long have you been looking for a pet?
Have you applied elsewhere? Yes No
If yes, where?
What is the status of that application or adoption?
Are you willing to allow a LCR representative into your home for a home visit Yes No
If no, why?
Are you aware that rescue pets may have unknown medical and behavior history? Yes No
What Each Applicant Should Know
  • LCR Pets will require the following vaccines/tests EVERY YEAR for the rest of their lives: DA2PLCPV/ (this vaccine covers distemper, hepatitis, leptospirosis,), Rabies (1 year or 3 year vaccines), Lyme (to protect against Iyme disease which is transmitted to pets through ticks). The costs for these vaccines/tests can be $200 or more/year per animal.
  • LCR is Rescue Dogs, unless otherwise stated, will come fully vaccinated, spayed/neutered and deemed healthy by a licensed veterinarian. However, we cannot guarantee the future health of any of our dogs.
  • LCR Dog Rescue cannot and do not guarantee breed or age of its dogs/puppies listed with us for adoption. We try our best assessments regarding both breed and approximate age.
  • By submitting an application to LCR does not obligate you to adopt nor does it guarantee the dog will be adopted to you.
  • LCR Dog Rescue does not work with first come first serve basis; we collect applications on the dog in question and make a determination on where we think the dog will do best.
  • LCR Dog Rescue makes every effort to process new applications as soon as possible; it may take up to 5 days to fully process your application. The volunteers at LCR work full time jobs and we do our volunteer work on our lunch hours, evenings and weekends. We cannot always reply ASAP to an application that has been placed.
  • LCR Board makes all adoption decisions and their decision is final.

I understand that completion of this application will in no way guarantees the adoption of this pet. Furthermore, any falsification of information will result in the immediate denial of this application. By signing this Application, I declare I am at least 21 years of age.

*When sending back an application via email, a signature is not required at this stage. Please print your name and include date*

Signature of Applicant / Date
Printed Name of Applicant / Date
For Last Chance Rescue Use Only
Application Received By: / Date:
Vet check ok? If no, explain
Date home visit performed:
Additional comments:
Application: Approved Denied / Date:

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