Adoption Application

NOTE: ALL FIELDS MUST BE COMPLETED! IF ANY FIELDS ARE LEFT BLANK, YOUR APPLICATION WILL NOT BE PROCESSED! IF YOU HAVE NOT RECEIVED AN E MAIL THAT YOUR APPLICATION WAS RECEIVED PLEASE E MAIL US AT lilpawsrescue@yahoo.com

Dogs Interested in:

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Cell Phone :

Email Address

Primary's Date of Birth

Spouse's Full Name

Spouse's Date Of Birth:

Name and Address of Primary's Employer:

Number of Years Employed:

Work Hours:

Name and Address of Spouse's Employer

Spouse's Work Hours

Names, Ages & Relationships of Chldren
Linving and / or visiting household regularly

Years at Current Address

Please Indicate Current Living Situation

Do You?

Does Your Home Have A Fence?

Indicate the type and height of
fence - ie: wood, 6 ft

Is Gate Padlocked/secure underground?

Is someone home during the day?

If no, where will the dog stay?

Will you take your dog to
Obedience Class if needed?

What Gender Are You Looking For?

Age Preference

Why do you want a dog?

Under what circumstances would you give up your dog?

Please list the animals you currently have
Name, Breed, Gender, Age

Are your pets current on all vaccinations?

Are all your pets Spayed and/ or neutered?

Are your pets on Heartworm and Flea Preventitives?
Please list Brand used

Name and Phone Number of Your Veternarian and
Names your Pets are under at the Vets Office

Date of your pets last vet visit

List all pets you have owned in the past 10 years

If not with you any longer, where are they?

How did you hear about LIL PAWS RESCUE?

Although we vet all of our dogs prior to adopting them to new homes, we require the adoptive families to take their new dog to their own vet within two weeks of adoption. This is to make sure all is well, and start the dog on heartworm and flea preventatives. Do you have a problem with this?

We will attempt to provide you with an honest evaluation of temperament on any dog we have to place. Do you realize that often times the complete history of a rescue dog may not be known and you may encounter some behavioral problems?

Are you willing to work with us to correct these problems?

Please Provide Names,Phone Number and Email Address of THREE (3) References: List One (1) Relative please.
Allow space between each reference please

Additional Comments:

I certify that the information on this form is true and correct. I am also financially and physically able to care for this animal. I understand that proper food and vet care may be costly, and I am able to meet these requirements. HOME CHECKS are made on random basis following prior to adoption. If upon inspection we find that information contained in this application to be false, we retain the right to turn down or remove the animal from your premises WITHOUT refund of money paid.

Signature and Date Must appear Below

Indicates Response Required