PIT BULL PRE-ADOPTION APPLICATION FORM
Louisiana Animal Rescue
This questionnaire
constitutes only the first step in the process of adopting a Pit Bull from Louisiana Animal Rescue. The purpose of the questions is to detect adoption-related difficulties in advance so that we can try to match each dog to a home compatible with that dog. As the legal owners of our animals, the final decision about the adoption process is our decision. Falsification of the information requested is grounds for surrender, at the Adopter’s
expense, of any Louisiana Animal Rescue dog adopted.
PART 1
- Contact and Personal Information
1. First Name:
2. Last Name:
3. Street Address:
4. City:
5. State:
6. Zip Code:
7. Home Phone #:
8. Work Phone #:
9. Cell Phone #:
10. Email:
11. Occupation:
12. Who lives in the household?
PART 2 - Living Situation and Lifestyle
13. Where will dog stay during the day? At night?
14. Does everyone in the household want a Pit Bull?
15. Who will be responsible for taking care of the dog?
16. How many hours a day will the dog be home alone?
17. When home alone, where will dog be?
18. How will you exercise the dog?
19. Is the home in an urban, suburban, or rural setting?
20. How big is yard?
21. Is the yard enclosed by a fence?
22. If so, height and type of fence:
23. Do you own or rent?
24. If you are renting, please provide Landlord’s name and phone number for verification:
25. Does your municipality have breed specific restrictions?
26. If so, please describe the nature of the restrictions:
PART 3 - Other Pets and Experience
27. Do you have other pets?
28. If yes, please list all pets currently living in the household:
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Breed |
Gender |
Age |
Spay/Neuter |
Immunizations Up-To-Date |
Heartworm Prevention |
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29. Please list the dogs/cats you have owned in the past five years, excluding those still living with
you:
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Breed |
Gender |
Spay/Neuter |
Source of Animal |
Years Owned |
What happened to Animal |
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30. Of all the breeds available, why do you want a Pit Bull?
31. Experience: Please
relate any prior experience you have had with the Pit Bull breed:
32. References: Please
supply the name and phone number of your current veterinarian, or the one who saw your previous pet(s), with their title identification. If you don’t have a vet, please provide the name of your employer, clergyman,
or anyone not related to you who can attest to your character. Vet references
are preferred.
33. Additional information you would like to provide about yourself:
PART 4 - Liability and Responsibility
34. I agree to absolve Louisiana Animal Rescue and all of the representatives from any liability in
reference to a dog listed with Louisiana Animal Rescue. __________ (Initial)
35. I agree that the dog will not be used in any illegal activities nor be found at any time in a
municipality where Pit Bull presence is illegal. __________ (Initial)
36. I agree that the dog is to be kept as a house pet. The
dog shall not be sold for any reason. If I can no longer keep the dog, I will
contact Louisiana Animal Rescue and make arrangements to return the dog to Louisiana Animal Rescue. __________ (Initial)
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 ______________
