Adopt an Animal

Full Name

First NameLast Name

Wishing to adopt a

Animal's name

How did you select your potential pet?

You must be at least 21 years old to adopt a pet. Are you at least 21 years old?

Primary Phone

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

Best time to call

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you lived at the present address?

Type of residence

Rent?

Landlords Name

Landlords phone

Employer

Occupation

Work Phone

Are you planning to move within the next year?

If moving, what are your plans for your pet(s)?

Number of Adults in your household?

How many children in your household?

Is anyone in your household allergic to animals?

Are all members of your household aware of your plans to adopt?

Please provide at least two (2) personal references. Include their names, telehone numbers, and tell us how these people know you and your ability to provide a good home for an adopted pet. Note, These references must be familiar with your experience with animals and they can't be relatives.

Pet qualities you're looking for

Please tell us about the pets you currently own or have owned during the last two years.

Are your pets spayed/neutered and current on vaccinations?

Can you provide documentation?

Are your dogs tested for Heartworm and given preventative medicine?

If you are interested in a cat, do you plan on declawing?

If you plan to declaw, do you agree to declaw front paws only?

Do you administer flea and tic preventative to your pets?

*If any of the pets are not neutered or spayed, please explain.

If you no longer own any of these pets, please explain.

Name of veterinary clinic that has cared for your pet(s)

Have you applied to adopt an animal from La Crescent Animal Rescue or any other shelter before?

At any time, has a shelter turned down your adoption request?

Shelter name and contact information.

Reason for denial.

Where will your new pet be kept?

How will your pet be confined to your property if outside? (Check all that apply.)

How long will your pet be alone during a 24-hour period? (Hours)

When you are NOT home, where will you keep this pet?

If for any reason you can no longer keep your adopted pet, the pet must be returned to the La Crescent Animal Rescue. Do you agree to this policy?

What do you consider an acceptable reason for you to give up your pet?

Do you agree to take over all vet care responsibilities from the final adoption day and going forward unless otherwise noted on this form?

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For LAR: Date Adopted/Fee Paid