Animal Name: Gender: Male Female

Description:

Applicant's Full Name:

Address:     

City/State/Zip:

Email Address:     

Daytime Phone:     Alternative Phone:

Please provide reason for wanting a new pet:

Is the pet for: You Your Family Someone else

If someone else, who

How many hours per day will the animal be left alone? Less than 3  3-5  5-8  Over 8

Will the pet be kept Inside or Outside     

Where will your new pet sleep?

Have you previously owned other animals? Yes No

If yes, list pet(s) name(s) and tell what happened to each of them.

Do you currently have other pets? Yes No    If yes, how many and what is/are their name(s)?

Are your other pets spayed or neutered? Yes No
If no, give reasons:

Are your other pets current on shots, heartworm preventative, vet care? Yes No
If not, specify which pets and why not

Have you ever completed an application for a LAAR animal before? Yes No

Do you have children? Yes No   Ages     

Do you work outside the home? Yes No

Employer Name: Phone :

Address:

Drivers License #

Do you Rent or Own

If you rent, provide name and phone number of apartment complex/landlord:

Name Phone

Address

Do you have a fenced in yard? Yes No
What type of fencing: Wood Chain Link Brick Wall Other

How high is fencing: 4 feet 5 feet 6 feet Other    

 Do you have a pool? Yes No

What is the name of your current veterinarian:

Clinic Name: Phone:

Address:

Adoption Contract

This agreement is made between Lost Angels Animal Rescue, Inc. (further known as LAAR) and the adopter. By signing below, you are acknowledging receipt from LAAR, the dog described within the application. Adopting party must be 21 years of age or older and agree to be bound to and comply with the following terms and conditions (if completing online, please check each item; if completing in paper format, please initial each item):

I understand that a home visit by a LAAR representative is required as a condition of this adoption       approval.

I understand that written approval AND proof of deposit payment will be required from a landlord as       a condition of this adoption.

I will have this dog seen by a licensed veterinarian of my choice, at my expense, within 72 hours       from the date of this contract. Thereafter, I will have this dog examined at least one a year by a       veterinarian and immunized as recommended by that veterinarian, at my expense.

I will seek appropriate veterinary care and/or treatment for this dog if he/she should become sick or       injured.

I will provide a loving, safe, happy, clean, and gentle home for my new pet at all times.

I will provide proper and sufficient food and water for my new pet at all times. I understand that       premium pet foods are better for my dog and that certain grocery store brands have been linked to       diseases in animals. I will make every effort to provide the best food available at least twice a day       (i.e., Nutro, Iams, Eukanuba, etc).

I understand that I am adopting an indoor dog and will make him/her an indoor member of my       family. This animal shall never be maintained outside as a yard dog, and shall never be staked out       or chained.

I will keep my pet parasite and flea-free and will use a veterinarian-recommended product such as       Advantage, Frontline, or Revolution monthly. Generic store brands (i.e., Hartz) can be harmful or       deadly.

I will keep my pet on a heartworm preventative recommended by my veterinarian.

I will not permit this animal to run at large or to become a public nuisance, and will always keep       means of identification on him/her at all times. I will immediately retrieve this animal from any public       or private facility when notified. In the event this animal becomes lost, I will make every reasonable       effort to relocate and claim this animal including notifying LAAR.

I have been advised to clean my pet's ears and teeth regularly, and to trim his/her nails. I will       discuss this with my veterinarian if I have any difficulties.

This animal will not be transported in an open pickup truck or car.

No one in my home, including myself, had or now has a pet-related allergy that has not been       disclosed to LAAR.

If I can no longer keep or care for my pet at any time during his/her life, I agree to contact LAAR.       LAAR will only be able to take the dog back based on foster discretion and availability. If I return       this animal to LAAR for any reason, I will at no time assert any claim, charge or demand of any kind       or nature against LAAR for any charges that may have been incurred by me, including veterinarian       fees, in connection with this animal.

I will not use, sell, nor donate my pet for research purposes and understand that ownership of this       pet may not be transferred to any other person, firm, corporation or organization for any reason       whatsoever.

I understand that an animal can be unpredictable and that LAAR cannot anticipate or insure against       unexpected conduct of an animal adopted from LAAR. I acknowledge that LAAR has not made       through its volunteers, any warranties regarding the future condition, temperament or conduct of       this animal. I hereby accept this animal as is, assume all risks and responsibilities associated with       ownership of this animal, including bites, and I hereby fully and completely release, indemnify, and       hold harmless, LAAR, its directors, volunteers, and agents from any claim, cause of action or liability       of any sort or nature, whether, known or unknown, directly arising out of or in connection with the       adoption, care or ownership, maintenance, retention, temperament, conduct or condition of this       animal.

I agree to communicate with LAAR during the new pet adjustment period to ensure that a mutually       satisfactory relationship is established in the new home.

I agree to allow LAAR to visit my new pet in my home by appointment.

I agree to make a donation for each puppy/dog adopted. (Donations range from $125 to $400       depending on breed/size.) I understand that a fee of $25.00 and/or immediate return of this animal,       as deemed by a LAAR Director, will be incurred upon the receipt of an insufficient check.

I understand that my adoption donation is non-refundable.

This contract may be specifically enforceable by LAAR through judicial proceedings, including the       right of LAAR to recover the animal due to any breach of any terms of this contract. I hereby agree       that in the event I breach this contract and LAAR files suit to enforce this contract or to defend any       claims under this contract, I will pay any court costs and attorney's fees incurred by LAAR in       connection herewith.

By checking this box, I understand that this is considered a signed contract.

Signature of Adopter

Date

Print Name

       
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