Date

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Name

First

Last
Home/Cell Phone Number

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Alternate Phone Number

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Email
Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Name of pet you are interested in (if known):
If you do not have an exact pet in mind, that is OK! We will assist in finding a pet to match your household and lifestyle.
Why are you interested in adopting?
Is this pet going to be a gift? If so, to whom?
Do you Rent or Own your residence?
 Rent 
 Own 
If you rent, who is your LandLord and what is their contact information?
Please note: If you rent, you will need to be able to provide proof from your LandLord that you are allowed to have pets on the premises.
Are there children (under 18) in your household?

If yes, please describe how many and what their ages are.

Also, have the children been around pets before?

Does anyone in the household have animal allergies?

If so, what exactly are they allergic to and how do they control their outbreaks?
How many pets have you had in the past 10 years?
How many pets do you currently have? What are their species (cat, dog, rabbit, etc.)?
Are your current pets up-to-date on vaccinations?
Are your current pets spayed/neutered?
Who is your current veterinarian and what is their contact information (phone number and address)?
Lucky Paws reserves the right to contact your current veterinarian for a recommendation.
Are your current pets kept indoors, outdoors, or both?
 Indoor 
 Outdoor 
 Other (please explain) 
When you are away from home for short periods (at work, running errands, etc.), where do your pets stay?

(ie: do they have free roam of the house, are they caged or kept one room, are they leashed outside?)
When you are away from home for extended periods (vacationing), who provides for your pets?
How do you or how would you plan to correct any possible behavioral problems?
Have you declawed your cats in the past and do you plan on declawing your future cats?

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND THAT ANY FALSE INFORMATION WILL NULLIFY THE ADOPTION.

Electronic Signature
A Lucky Paws Animal Rescue Adoption Counselor will contact you within 24 hours. Lucky Paws Animal Rescue reserves the right to decline any adoption.
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