We are pleased that you have decided to give a homeless animal a second chance! The purpose of our adoption program is to find responsible life-long homes for animals suitable as family pets. In order to help ensure that the proposed adoption is in the best interest of both the animal and you, please complete the following application.

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Adoption Requirements – Please Read Carefully

____________________________PLEASE PRINT CLEARLY!_________________________________

Name of Primary Applicant:

Name(s) of any other adults living at the same address:

Address:

City: County: State: Zip:

Phones: Home: Work: Cell:

E-mail address: Driver’s License Number:

Adopter’s place of employment:

Name of Louisiana Animal Rescue adoption counselor who showed you the pet you wish to adopt:

Do you live in: house apartment duplex condo townhouse in parents’ home

Do you own the home you currently live in? If you rent or your residence has animal restrictions, please read the box below:

What restrictions does your landlord/association have regarding pet, such as weight, type or quantity?

Name of apartment or condominium complex:

Landlord/Property Manager Name: Telephone #:

How many adults live in your home (all names must be listed above)? How many children live in your home? Ages of children: Do you frequently have children visit your home?

Do you expect any of the following to happen in the near future: moving new baby acquisition of other pets job change/transfer marriage/divorce

other

1. How many hours a day will the dog be alone? 2. Where will it stay?

3. How do you plan on confining the dog to your property when it is outside?

4. Why do you want to adopt this particular dog?

5. What behavior(s) would you find undesirable? excessive barking jumping digging chewing

other (please describe) _______________________________________________________

6. What would you do if your adopted dog started exhibiting such behavior?

7. Do you understand that you are required to have your dog vaccinated against rabies, and that your local jurisdiction may require the dog to be licensed every year? Yes No

1. This cat will live primarily indoors outdoors both

(please note: if the cat has been declawed it should never be allowed outdoors)

2. Are you aware that it could take this cat several weeks (at minimum) to become adjusted to you, your home, and your other pets? Yes No

3. Do you understand that cats need daily attention and care (such as fresh food and water, access to a clean litterbox(es), etc)? Yes No

4. Why do you want to adopt this particular cat?

5. What behavior(s) would you find undesirable? scratching house soiling other (please describe)

6. What would you do if your adopted cat started exhibiting such behavior?

7. Do you understand and agree that if for some reason you could no longer keep this cat, you must return it to the Louisiana Animal Rescue? Yes No

Have you ever applied for, or adopted an animal from this shelter? Yes No

Have you ever brought animals to a shelter? Yes No If yes, why?

Do you or anyone living in your household have allergies to pets? Yes No

Do you have any pets at this time? Yes No If so, please list their information below (please ask for additional paper to list other animals, if necessary):

Who is your current veterinarian? Phone:

I certify that I have never been convicted of animal cruelty, neglect or abandonment, as required pursuant to Louisiana of the Codified Ordinances.

I understand and agree that the Louisiana Animal Rescue makes no representations or guarantees about any animal’s health, temperament, and/or behavior. All applicants further understand and agree that any information about an animal (i.e. "animal is good with children," "housebroken") is based upon information provided by the previous owner and is believed to be true. All applicants understand and agree that the Louisiana Animal Rescue are not liable for any future injury or damage which may be caused by this animal.

I understand and agree that I have a legal obligation to provide the animal I am adopting with whatever prompt veterinary intervention the animal needs to avoid pain and suffering, at my own expense, including any conditions known to the Department, such as:

I understand that the Louisiana Animal Rescue will not be responsible for any medical expenses once the animal leaves the shelter, nor will the Department of Animal Care & Control be responsible for any additional spay/neuter fees beyond the actual surgery itself. I further understand that it is my responsibility to contact the veterinarian performing the surgery and determine what, if any, extra fees will apply.

I certify that all information provided herein is correct and accurate to the best of my knowledge and that should any information change I will immediately contact the shelter, and I understand that my application may be denied if any of the information provided herein is false.

The information provided on this application is correct.  I understand that, should I adopt a dog from Louisiana Animal Rescue, falsification of any information may result in my returning the animal to Louisiana Animal Rescue.  I also understand that a member of Louisiana Animal Rescue may telephone me periodically or visit my home as a routine post-adoption procedure. Louisiana Animal Rescue can and will prosecute according to State of Louisiana Animal Laws when found to be falsification and or used in any type of illegal activities, animal cruelty, neglected or abandoned along with any other violated State of Louisiana Animal Laws. Failure to surrender animal or to notify of any information changes, Contact number, change of Address, change of names, another pet entering the home, another member of family entering home except babies born, change of job, change in income or any other and above description of Louisiana Animal Rescue rules or State of Louisiana animal laws will result in imprisonment and or fines. Further more, Louisiana Animal Rescue has the right to enter the home or property to seize animal at any cost incurred at owner’s liability and cost in case of any damages incurred during retrieval of animal. Louisiana Animal Rescue is not responsible for any damages caused by dog. Louisiana Animal Rescue will not be responsible for the cost of spay or neuter, that cost will be paid prior to adoption at prospective adopters and will be carried out before placement. Louisiana Animal Rescue doesn't warrenty animals health nor will we be responsible for any death or serious animal health issues after placement. By singing your name to this document you’re entering a legal and binding contract. Further more you accept the terms and agreement at sound mind. All fees are non-refunded, you will forfit any adoption fees and cost to spay or neuter if you decide the placement did not work out, changing of mind, sudden changes on your behalf and or if founded falsification after or prior to adoption. By signing this adoption contract you agree not to hold Louisiana Animal Rescue responsible for anything where is, this means no suit of any nature will or can be filed against Louisiana Animal Rescue. Their will be no written or verbal changes in this agreement. All changes must be made on this contract or another typed contract stamped with the Louisiana Stamp Seal by a notary at your exspense and a Louisiana Animal Rescue Counsler must be present at time of agreement is legalized and filed at Louisiana Animal Rescue.

Prospective Adopter’s Signature ____________________________  Date:__________

Co-owner signature: ______________________ Date: _______________________

Co-owner signature: ________________________ Date: _______________________

Animal ID#: ______________ Breed: _______________ Color: ________________

Age: ______ Sex: _______ Name:__________________ Date Available:__________

This is a: First Hold ________ Second Hold ________ Other ________

ÿ Landlord’s/Property Manger’s written permission ÿ Reference information

ÿ Signature/approval of co-applicant ÿ Home check

ÿ Out-of-county agency check (specify County, State):____________________________

ÿ Behavioral consultation (specify appointment date/time)__________________________

ÿ Meet & greet (specify appointment date/time)_________________________________

ÿ Other:______________________________________________________________

ÿ Computer Checked ÿ Home Check Ordered ÿHome check Done ÿ County agency checked

ÿ Adoption APPROVED ÿ Adoption Approved Pending: ÿLLD approval ÿ dog license(s)

ÿ co-applicant signature ÿ other: __________________________________________

ÿ Adoption DENIED due to:_____________________________________________________