Adoption Form

To help us keep track of all the people who want to give our dogs wonderful homes, we need you to fill out an adoption form. An application does not mean you are required to adopt: it just lets us know you are seriously considering an animal for adoption.

Name Name First Last
Email
Primary animal you're interested in
Address (CANNOT BE A PO BOX) Address (CANNOT BE A PO BOX)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Mobile Phone Mobile Phone - ### - ### ####
How many adults are in the home
How many children are in the home
Ages of children
Is yard completely enclosed by fence?

Is yard completely enclosed by fence? Yes No
Give type of fence and height
May we visit your home?

May we visit your home? Yes No
Will there be any other animals in the home?

Will there be any other animals in the home? Yes No
If answer is yes, please give names, ages, and breeds (if mixed breed, give the most prominent breed)
Please share names and species of animals in your possession within the last 10 years (other than ones listed above)
Vet reference: Name, address, phone number
Personal Reference and phone number (NO FAMILY MEMBERS). If no vet reference is given, please give two personal references with phone numbers
I agree that the statements given on this form are truthful; I have made no false statements with regard to family, numbers of people/animals in household; references provided (again, no family members); or any other statements made upon this application. I agree I am not adopting in proxy for any other individual. I agree if for any reason I no longer wish to own the adopted animal, I will return the animal to LCHS.
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