League for Animal Welfare

Adoption Form

* indicates required field

LFAW is committed to finding permanent, responsible, loving homes for all our animals. Please complete all questions below to help us find you the right pet for your home! The adoption process includes this survey, then an interview, and approval/denial. LFAW reserves the right to refuse an adoption to anyone for any reason. Thank you for your time and cooperation.

Adopter Information

* First Name: * First Name:

* Last Name: * Last Name:

* Are You Over 18?:

* Number of Adults in Household Including Yourself: * Number of Adults in Household Including Yourself:

* How many persons under age 18 live in your residence?: * How many persons under age 18 live in your residence?:

What Are their Ages?: What Are their Ages?:

* Do all of the adults in your household know that you are planning to adopt a new pet? :

* Does anyone in household have pet allergies?:

* Who will be the primary person responsible for this pet? : * Who will be the primary person responsible for this pet? :

* Do you * Do you: Work Full-time Work Part-time Attend School Retired Other

If Other, Please Specify: If Other, Please Specify:

* What major lifestyle Changes Do You Anticipate In The Next Two Years? (Check All That Apply): * What major lifestyle Changes Do You Anticipate In The Next Two Years? (Check All That Apply):: Moving Marriage College New Baby Other

If Other, Please Specify: If Other, Please Specify:

Pet Information

Do you have a particular pet in mind that you would like to adopt? Do you have a particular pet in mind that you would like to adopt?: Yes No

If yes, what is the name of the pet(s)?: If yes, what is the name of the pet(s)?:

* Who Is This Pet For?:

If Other or Gift, Please Specify: If Other or Gift, Please Specify:

* Why Are You Looking to Adopt a Pet?: * Why Are You Looking to Adopt a Pet?

* My Pet Will Live:

If Other, Please Specify: If Other, Please Specify:

If You Are Interested In a DOG, Please Check All That You Would Consider: If You Are Interested In a DOG, Please Check All That You Would Consider:: Puppy Adult Senior Small (<25 lbs.) Medium (25-50 lbs.) Large (>50 lbs.)

How Will the Dog Get Exercise?: How Will the Dog Get Exercise?:

If You Are Interested In a CAT, Please Check All That You Would Consider: If You Are Interested In a CAT, Please Check All That You Would Consider:: Kitten Adult Senior Short Hair Long hair

Specific Color?: Specific Color?:

If Other, Please Specify: If Other, Please Specify:

Please List Pets You Have Had Over The Last Five Years

Pet #1

(Pet #1) Type/Breed?: (Pet #1) Type/Breed?:

(Pet #1) Sex:

(Pet #1) Spayed/Neutered? (Pet #1) Spayed/Neutered?: Yes No

(Pet #1) Age: (Pet #1) Age:

(Pet #1) Kept Where?: (Pet #1) Kept Where?:

(Pet #1) Still Own? (Pet #1) Still Own?: Yes No

(Pet #1) If not, What Happened?: (Pet #1) If not, What Happened?:

Pet #2

(Pet #2) Type/Breed?: (Pet #2) Type/Breed?:

(Pet #2) Sex:

(Pet #2) Spayed/Neutered? (Pet #2) Spayed/Neutered?: Yes No

(Pet #2) Age: (Pet #2) Age:

(Pet #2) Kept Where?: (Pet #2) Kept Where?:

(Pet #2) Still Own? (Pet #2) Still Own?: Yes No

(Pet #2) If not, What Happened?: (Pet #2) If not, What Happened?:

Pet #3

(Pet #3) Type/Breed?: (Pet #3) Type/Breed?:

(Pet #3) Sex:

(Pet #3) Spayed/Neutered? (Pet #3) Spayed/Neutered?: Yes No

(Pet #3) Age: (Pet #3) Age:

(Pet #3) Kept Where?: (Pet #3) Kept Where?:

(Pet #3) Still Own? (Pet #3) Still Own?: Yes No

(Pet #3) If not, What Happened?: (Pet #3) If not, What Happened?:

Pet #4

(Pet #4) Type/Breed?: (Pet #4) Type/Breed?:

(Pet #4) Sex:

(Pet #4) Spayed/Neutered? (Pet #4) Spayed/Neutered?: Yes No

(Pet #4) Age: (Pet #4) Age:

(Pet #4) Kept Where?: (Pet #4) Kept Where?:

(Pet #4) Still Own? (Pet #4) Still Own?: Yes No

(Pet #4) If not, What Happened?: (Pet #4) If not, What Happened?:

* Have You Adopted From Another Rescue Group Organization In The Past? * Have You Adopted From Another Rescue Group Organization In The Past?: Yes No

If Yes, What Organization?: If Yes, What Organization?:

If Yes, When?: If Yes, When?

* What Do You Feel Is a Proper Adjustment Period For You and Your New Pet?: * What Do You Feel Is a Proper Adjustment Period For You and Your New Pet?:

* How Would You Handle Any Behavior Problems?: * How Would You Handle Any Behavior Problems?:

* What Circumstances or Issues Would Give Rise to Your Considering Returning or Rehoming This Pet?: * What Circumstances or Issues Would Give Rise to Your Considering Returning or Rehoming This Pet?:

* Name of Current Veterinarian/Animal Hospital or the Veterinarian That You Will Use: * Name of Current Veterinarian/Animal Hospital or the Veterinarian That You Will Use:

* Their Phone Number: * Their Phone Number

What Other Questions/Topics Would You Like To Discuss?: What Other Questions/Topics Would You Like To Discuss?

Residential Information

* Address: * Address:

* City: * City:

* State:

* ZIP: * ZIP:

* Primary Phone: * Primary Phone

Secondary Phone: Secondary Phone

* Email Address: * Email Address

* Do You * Do You: Own Your Home Rent Your Home Live With Family Other

If Other, Please Specify: If Other, Please Specify:

* Type of Residence * Type of Residence: House Condo Townhouse Apartment Mobile Home

* Do You Have a Fenced Yard? * Do You Have a Fenced Yard?: Yes No

Type of Fence?: Type of Fence?:

Height?: Height?:

If You Do Not Have a Fence, Would You Consider Getting One? If You Do Not Have a Fence, Would You Consider Getting One?: Yes No

If Yes, What Kind?: If Yes, What Kind?:

If You Rent

Landlord's First Name: Landlord's First Name:

Landlord's Last Name: Landlord's Last Name:

Landlord's Phone Number: Landlord's Phone Number

What Are Your Pet Restrictions (Type, Breed, Number, Weight)?: What Are Your Pet Restrictions (Type, Breed, Number, Weight)?

I Attest the Above Information Is True and Accurate

* Signature: * Signature:

* Date: * Date

* How Did You Hear About Us?:

If Other, Please Specify: If Other, Please Specify: