Adoption Application

Adopter’s Name *

Phone *

Address *

City *

State *

ZIP *

Email

Employer

Would you like to be added to the LV email list?

Yes
No

How did you find out about LV?

What is your reason for adopting a cat?

Family pet
For children
Companion for pet
Farm/barn

What is your reason for adopting a dog?

Family pet
Companion for pet
Protection
Other

1. Housing

Own
Rent

How long at this address?

2. Do you have a yard?:

Yes
No

Size

Fenced?

Yes
No

Type

3. Name of Landlord or complex:

Phone

4. Are you planning on moving any time soon?:

Yes
No

If yes, how soon?

5. Your household consists of:

Adults only
Live alone
Family with children

Ages

6. The activity level in our home is: *

Quiet
Active
Hectic

7. Is there anyone home during the day?

Yes
No

Hours at home:

8. In a 24-hour day, how long will the pet be left alone? *

9. Where will the pet be primarily living? *

Inside
Outside

10. Where will the pet be sleeping at night? *

11. Where will the pet stay when not at home? *

12. Do any members of the family have allergies to animals? *

Yes
No

Who?

13. Who will be the primary caretaker of the pet? *

If you become unable to care for the pet, who will assume responsibility for it?

14. Have you ever surrendered a pet to LV or any other shelter? *

Yes
No

If yes, for what reason?

15. Please check one: *

First time pet owner
Had pets when growing up
Have always had pets

16. Average annual cost for a dog can meet/exceed $675. For a cat it can meet/exceed $355. Boarding costs can be additional. Have you considered this addition to your budget and the impact it will have on your family & lifestyle? *

Yes
No

Tell Us About Your Pets

17. Current Pets living on your property: *

Please include Name, Type, Age, Sex, Spayed/Neutered, What happened to the pet, and When

18. Who is your Veterinarian? *

19. Are your pets current on vaccinations? (We will verify records with listed veterinarian.) *

Yes
No

Please Tell Us What You’re Looking For In A Pet

20. Pet selection preferences:

Name(s) of animal(s) interested in: *

Sex: *

Male
Female
No preferences

Age: *

Puppy/kitten
Teenager
Adult
No preferences

Size: *

Small
Medium
Large
No preferences

Activity Level: *

Very Active
Semi-Active
Calm
No preferences

21. Please note any qualities or traits desired: *

23. Do you have any questions or concerns? *

I understand the above questions in this application and authorize LV to contact my landlord for verification. I understand that misrepresentation or mission of facts called for is cause for denial of adoption. The information I’ve provided is true and complete to the best of my knowledge.

Applicant’s signature: *

Date: *

ADOPT/FOSTER

LITTLE VICTORIES ANIMAL RESCUE GROUP, INC.

Tell Us About Your Pets

Please Tell Us What You’re Looking For In A Pet

20. Pet selection preferences: