First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Alt Email
Name of the dog you are applying for? Choose an animal: ADELE ALEX ARCHIE ARLO ARLO (Hound) ARMARETTO ASHE ATHENA AVA BEAR BEE BELLA BILLI BINX BIRCH BLUEY BRIXTON BROWNIE BURTON CAL CALI CASSEROLE CHIEF AKA SKUNK COCO CODY COMET CUTTER CYNTHIA DAPHNE DaVINCI DELILAH(terrier) DIAMOND DINO DOGULA DOLLY EBONY EEYORE Eleanor ELIJAH ENZO FERGAL aka RAMBO FERN FERRIS FINLO FOZZY BEAR GENERIC KITTEN GHOST GOUDA GREEN BEAN GREY GROVER HAYWOOD HENRY HOLLY HOPE JR KATE KENNEDY KREME nka Maddie LADY LASAGNA LAYLA LEE LINDA LOKI LOU LOUIE MAC & CHEESE MADISON MAGGIE (SHIRLEY - Boston Terrier mix) MASON MATSON MAUI MEDUSA MITCHELL MOON PIE NAOMI OAKLEY ODIN OREO PAMELA PAW PAW PEAR PECAN PIP RAIN RED REUBEN ROSCOE SADIE SALVADOR SAMMY SAPPHIRE SARAH SCOUT SKIPPER SKULLY SOPHIE STELLINE SUMMER TEDDY TEDDY BEAR TRISH TULIP TULIP VEGAS WHISKEY WINK WINONA XYLA YANCEY YEOL ZANDY
Name of the dog, if you are applying for more than one? Choose an animal: ADELE ALEX ARCHIE ARLO ARLO (Hound) ARMARETTO ASHE ATHENA AVA BEAR BEE BELLA BILLI BINX BIRCH BLUEY BRIXTON BROWNIE BURTON CAL CALI CASSEROLE CHIEF AKA SKUNK COCO CODY COMET CUTTER CYNTHIA DAPHNE DaVINCI DELILAH(terrier) DIAMOND DINO DOGULA DOLLY EBONY EEYORE Eleanor ELIJAH ENZO FERGAL aka RAMBO FERN FERRIS FINLO FOZZY BEAR GENERIC KITTEN GHOST GOUDA GREEN BEAN GREY GROVER HAYWOOD HENRY HOLLY HOPE JR KATE KENNEDY KREME nka Maddie LADY LASAGNA LAYLA LEE LINDA LOKI LOU LOUIE MAC & CHEESE MADISON MAGGIE (SHIRLEY - Boston Terrier mix) MASON MATSON MAUI MEDUSA MITCHELL MOON PIE NAOMI OAKLEY ODIN OREO PAMELA PAW PAW PEAR PECAN PIP RAIN RED REUBEN ROSCOE SADIE SALVADOR SAMMY SAPPHIRE SARAH SCOUT SKIPPER SKULLY SOPHIE STELLINE SUMMER TEDDY TEDDY BEAR TRISH TULIP TULIP VEGAS WHISKEY WINK WINONA XYLA YANCEY YEOL ZANDY
If you are applying for a specific dog would you consider another if that one were not available?
If you are not applying for a specific dog please describe the breed/age of dog you are looking to adopt.
Where did you learn about Last Chance Animal Rescue / St Francis Farm Animal Sanctuary?
What is the name of your employer? Enter self or retired if appropriate.
What is your current job title?
Employed since? (MO/YR)
What is your date of birth? (**We DO NOT adopt or allow someone to foster under 21 years of age**)*
Please list all members of your household other than yourself. Please include their relationship to you and their ages.
Does any member of your family have any allergies to animals? Choose one: Yes No
How many cats are part of your family?
How many dogs are part of your family?
Please provide details if allergies are a consideration.
Do you have other pets? Please specify.
What type of home do you live in?* Choose one: Apartment Condominium House
Do you own your home, rent your home or live with your parents? * Choose one: Live with Parents Own Rent
If renting, please enter your landlord's name and phone number. If you are living with family/parents please provide a contact for the home owner.
If you rent, have you received the approval of your landlord to have an animal? Choose one: Yes No
Do you have a fenced in yard? Choose one: Yes No
What type of fence? Choose one: Privacy Chain Link Invisible
If so, what is the approximate height of the fence?
Is the fence attached to the house? Choose one: Yes No
Please provide your Veterinarian's Name and Phone Number (Current/Past Pets) Enter N/A if this does not apply*
Name, type of animal, age and gender for current pets.
Are these pets Spayed/Neutered? Choose one: Yes No
Are these pets up to date on their shots? Choose one: Yes No
Please provide any additional details/comments about your existing pets.
Please describe all the pets you have previously owned in the last 10 years (MUST include Name, Type of Animal, Age, Gender, Year you got the animal, Year deceased, Cause of death or the last year you had the pet and where they are now).
Were these pets Spayed/Neutered? Choose one: Yes No
Please provide any additional details/comments about your previous pets.
Please provide NON-FAMILY reference, including name, phone # and their relationship to you.*
Please provide a NON-FAMILY reference, including name, phone # and their relationship to you.*
Are you willing to properly train your dog?*
Are you willing to take the time to housebreak a dog, and do you understand that changing a dog’s environment may cause the dog to have accidents?* Choose one: Yes No
If a behavioral problem arises, what steps will you take to work on it?*
How often will you exercise the dog and for approximately how long?*
Who will be responsible for feeding and taking the dog outside?*
Who will take care of the dog in your absence? *
How much time will the animal spend alone during the day*
Where will the dog be kept when you are not home*
Are you willing and able to accept financial responsibility for the expenses associated with caring for a dog? This includes preventative health care such as annual check-ups, vaccinations and emergency medical care in the event of illness or injury? This is in addition to regular care with the cost of food, supplies and equipment, toys, training and boarding? Please explain:*
Are you aware of the adoption fee of $600 (All dogs) $300 - (For dogs deemed seniors by LCAR -generally 8 yrs and older) $200 - (For senior citizens over 65 yrs of age adopting senior dogs) * Choose one: Yes No
Would you object to an LCAR or SFF representative visiting your dog in their new home? ___Yes ___No
I, undersigned, agree to the following statements: • The information I provide will be verified before I am approved for adoption. • False statements or omissions of any of the above information will result in automatic refusal of adoption or confiscation of the animal. • LCAR has the right to refuse the adoption of any pet to any person. • The adoption fee is non-refundable. • I am willing and able to accept financial responsibility for the expenses associated with caring for a dog including preventative health care including annual check-up and vaccinations as well as emergency medical care in the event of illness or injury in addition to cost of regular care and feeding .(food, supplies and equipment, toys, training and boarding). • I understand that this animal will require training to reach its full potential. I fully understand the risks involved with interacting with animals and agree to assume all liability. I agree to hold Last Chance Animal Rescue and any and all of its affiliate programs harmless for any injury(s), loss or damages which I might sustain from interacting with the animals. This waiver includes myself, all of my family members and descendants forever from seeking any legal action whatsoever against Last Chance Animal Rescue or its successor organizations or any representatives thereof. Enter your name and today's date*
Drivers License #, State of issue and Expiration date. You will be required to provide a copy of this license upon signing the adoption contract
