Pet Adoption Application

Perspective Pet Parent *

First Name Last Name

Name of Pet You Wish to Adopt *

Email Address *

Phone Number *

Area Code Phone Number

Driver License Number *

License Number

Issuing State *

Address *

Street Address

Street Address Line 2

City State

Zip Code

Do you own any pets? *

If yes,Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other pets?

Do you own or rent your home? *

Own Rent

Do you have a yard? *

Yes No

If "Yes" to the above, is it fenced? please describe

If renting, What is your landlord's pet policy? *

If you rent, please provide your landlord's information here: *

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter? *

Yes No

Are there children in the home? (If yes, please list ages) *

If you answered "Yes" to the above question, are they responsible with pets?

Will the cat be indoor only? *

Yes No n/a

If you answered "No" to the above question, please provide detail:

Will the dog be kept outdoors? *

Yes No n/a

If you answered "Yes" to the above question, please provide detail:

Would you declaw a cat? *

Yes No

How many hours per day would the pet be alone? *

Will you crate your pet? for how long? *

If you have to leave town, emergently or planned, where would your pet stay? *

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet? *

Please provide the names, emails, and contact numbers for 3 personal references: *

What are your thoughts or views on animals used as bait and the "sport" of dog fighting? *

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment? *

Yes No

If you answered "Yes" please provide a detailed description:

By clicking the submit button, I agree to Lori's Angels Animal Rescue adoption process, will undergo a homecheck, and interview at the discretion of Lori's Angels Animal Rescue.
By clicking the submit button, I understand Lori's Angels Animal Rescue will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Lori's Angels Animal Rescue and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Lori's Angels Animal Rescue BY EMAIL and provide a 14 day period to allow Lori's Angels Animal Rescue to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Lori's Angels Animal Rescue against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Lori's Angels Animal Rescue will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Lori's Angels Animal Rescue and provide transport to where Lori's Angels Animal Rescue deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent *