Canine Adoption Agreement and Application
In order that we may be assured that the animal you are applying for will be best suited to your home and lifestyle, and that it will be placed in an environment that is compatible with its needs, please read the below agreement and fill out the application completely. Failure to fill out application completely may result in a denial of application.
Completion of this agreement does NOT guarantee that you will be approved for the adoption of this pet. Lady Luck Animal Rescue, Inc., is dedicated to placing our furry friends in the best homes possible. Therefore, we may decide to take more than one “pre-adopt” on any of our animals and will contact references that you have provided to ensure that we make the best decision for both the potential adopting individual/family and the pet. We appreciate your patience while we make our decision. After all this decision will be one that will last for the lifetime of your pet!
REGISTRATION #CH33131. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. 1-800-HELP-FLA (435-7352) www.FloridaConsumerHelp.com
Full Name of Applicant
Name of Pet Applying For
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Papua New Guinea
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
United Arab Emirates
United States Minor Outlying Islands
Virgin Islands, British
Virgin Islands, U.S.
Home / Cell Phone
Place of Employment / How Long?
Name and Telephone # of Vet / Vet Clinic
Reference #1: Name/Relationship/Telephone
Reference #2: Name/Relationship/Telephone
Is this an impulse adoption?
How did you hear about this pet?
Is this adoption a gift for someone else?
Do you own or rent you residence?
If you rent, you must show approval from your rental office or homeowner that animal/breed/weight is allowed. Can you comply?
What is the name and phone number of your landlord?
How long have you been at this residence?
If you are a smoker, do you smoke inside of your home?
I do not smoke
Do you have a backyard?
Is it fenced?
What kind? How tall?
Will you put a lock on the gate(s) so the meter man, lawn service, children won't leave it open?
How will this pet exercise?
Where will this pet live (check all that apply)
How will this pet spend its time home alone? (check all that apply)
Indoors, No Restrictions
Indoors, Room restricted
Outdoors, No Restrictions
How many hours a day on average will this dog be home alone?
How long do you intend to keep this animal?
if you move, are you willing to bring this dog to live with you in your new residence?
Maybe, if new home allows pets
Have you ever given a pet to a Shelter/Friend/Family?
If Yes, why?
Number of adults in household?
Number of children / ages?
Does in anyone in household have allergies to animals?
Do you own any other pets?
Are your pets spayed/neutered/up to date on vaccinations?
Are your pets on monthly flea/tick prevention? Heartworm prevention?
Are you aware that regular veterinarian bills can run between $100 to $500 a year?
Are all persons living in this household agreeable to adopting this dog?
What type of pets have you had? Breed/type/sex/age/spayed/neutered (please list each and what happened to them.)
Lady Luck Animal Rescue has a "no refund" policy. is this acceptable to you?
Terms/Conditions/Release of Liability:
It is strongly recommended that all adopted dogs be enrolled in professional obedience training.
Lady Luck Animal Rescue, Inc. believes that all pets should be indoor only pets. The animals we adopt out are never to be allowed to roam outside due to the potential hazard of getting hit/run over by vehicles, injuries from other wild or domesticated animals/spreading of disease. The adopter of this animal will purchase a pet carrier/crate large enough for the pet to stand up and turn around in.
LADY LUCK ANIMAL RESCUE RESERVES THE RIGHT TO TAKE BACK ANY PET THAT IS FOUND CHAINED OR TIED UP, ABUSED OR NEGLECTED IN ANY WAY, OR NOT BEING PROPERLY CARED FOR.
RELEASE OF LIABILITY: I release Lady Luck Animal Rescue, Inc., its Board of Directors, volunteers, foster volunteers and representatives, and the veterinarian treating the animal at the request of Lady Luck Animal Rescue, Inc., from any and all claims and actions, whether it’s for property damage caused by the animal(s) or for personal injury to me, family members, any other person and any other animal (including personal pets, livestock, or other animals) from biting, scratching, transmittal of disease, and/or any other matter attributable to said animal(s).
MEDICAL RELEASE OF LIABILITY: Lady Luck Animal Rescue will not be responsible for any medical bills for your pet after adoption unless arranged for at time of adoption.
I/We further understand and agree:
1. To return the dog to the Lady Luck Animal Rescue (LLAR) if unable to keep the dog. To never abandon the dog or surrender, sell, or give the dog to a shelter, pet dealer, or a laboratory.
2. To notify LLAR if the dog is lost or stolen and to make all reasonable efforts to locate the dog.
3. To never allow this dog to be trained for or used for protection or as an attack dog.
4. To treat this dog as a family pet with affection and kindness, never subjecting this dog to abuse or cruelty.
5. To provide regular veterinary care, including annual shots, heartworm preventative, and parasite checks.
6. To always keep this dog within a fenced yard (not on a chain), on a leash, or safely within the home.
7. To not transport this dog unconfined in an open vehicle.
8. To regularly check the tightness of any collar. To affix any licenses and tags to the collar and to never leave a choke chain on the dog when not attended.
9. To allow LLAR to make follow-up calls and/or visits.
10. To contact LLAR, a veterinarian, or an obedience trainer when problems arise so that the problem may be eliminated or alleviated.
I/we further understand and agree that:
1. Non-compliance with any of the above terms and conditions may result in the immediate forfeiture of the dog and that LLAR may reclaim this dog without payment of compensation to me/us.
2. LLAR has explained the typical characteristics and temperament of the pet.
3. LLAR has advised me/us that the dog can sometimes dig, chew, soil, and exhibit other undesirable traits unless properly supervised, confined, and trained.
4. LLAR has given me all information necessary to make an informed decision to adopt this dog.
In consideration of the adoption of this dog, I/we agree to assume full responsibility for the conduct of this dog upon the date of this contract. I/we further agree to hold harmless Lady Luck Animal Rescue, its board of directors, its officers, its volunteers, and any individuals associated with LLAR and to indemnify such organizations or individuals for any damages or costs resulting from liability, known or unknown, anticipated or unanticipated, as a result of the dog's conduct after the date of this adoption contract.
I have read the terms of this application and the adoption of the pet that I am applying for, and by signing below I certify that the information I gave in this application is true, and any misrepresentation of facts may result in my losing the privilege of adopting a pet through Lady Luck Animal Rescue in the future and the forfeiture of this dog or cat. Also by signing below I agree to all the terms as set forth herein by Lady Luck Animal Rescue in this application.
Do Not Fill This Out