First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Cell Phone*

Text/Pager Email

Which animal are you interested in
Choose an animal: Abby Lee Miller Adoption Archer Bailey Baloo Bessie Biscuit Blaze Cash Elsa Herbie Jasmine JD Koda Lady Maddie Mama Merrick Mulan Noodles Ranger Sammie Scrappy Sha’Cari Simone Suni Zeus

Why do you wish to adopt and why this dog and at this time? *

Veterinarian's Name and Phone Number. If you do not have a current pet or vet, please give us the name and number of your previous vet. We do require all pets to be up to date on vaccinations unless there are extenuating circumstances such as age or illness.*

List a minimum of two references and their phone numbers (not family members or related). You may list up to four references, which will be helpful in the event we are not able to get a hold of one of them. We must be able to speak with at least two references regarding their perception of your experience and ability to care for a dog.*

Do you own or rent your home*
Choose one: Rent Own

If you own your home, do you have an HOA that has breed restrictions or limits the number of dogs allowed?

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

How many people reside in your household - please list names, relationships and ages*

If there is more than one adult in the household, are all decision making adults in agreement with the decision to adopt a dog?*
Choose one: Yes No

Please list and describe the pets you currently have in your family - type of animal, breed, age, etc. Are they spayed or neutered and up to date on vaccinations?*

Have you ever adopted a pet from LSAR? If yes, name of pet and year adopted.*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

Who in the household will care for the pet*

How much time will the animal spend alone during the day*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal sleep*

Where will the animal be kept when you are not home*

What traits are you looking for in a pet

Some rescue dogs have little to no training. Are you willing to work with a dog on basics such as crate training, leash walking and housebreaking? What training experience do you have?*

Have you ever given up a pet? If yes, please explain*

What is your plan for your pets in the event you are unable or incapable of caring for them either temporarily or long term?*

How did you hear about us*

Have you applied with any other rescue*
Choose one: Yes No