First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Alt Email
Name of the animal you are interested in? Choose an animal: ALEX ALEXANDRA ALICE ALOE ARCHIE ARCHIE ASIA BASHFUL BEE BEE BERT BETHANY BETHANY BILLI BINDI BINKY BISCUIT BISCUIT BLAIR BLOOM BO DUKE BOB BONZI BROWNIE BUSTER CAL CAMOUFLAGE CARAMEL CASHMERE CHAN CHARLIE CHASE B CHEETO CHIBBS CLAIRE CLARIA CLIFTON CLOVE COLTER COLTER DAFFODIL DAISY DUKE DAMIEN DARLA DAWN DELILAH(terrier) DOC DOLLY DOUG DUDLEY DWIGHT EBONY EDWIN ELEANOR ELF ELLE ELLIE ELSA EMMALINE EMMET EVEREST EVIE FELICIA FERGAL aka RAMBO FERN FILLET GAGA GAGA GEMMA GENERIC KITTEN GHOST GILL GIZMO GOOBER GRAVY GRUMPY GUCCI GUS HAPPY HARLEY HAZEL HENRIETTA HERCULES HOLLY HOUDINI IVY JAFAR JAX JR JUDE KALA KAREN KATE KATTIE KEELEY KINGFISHER KORBIN KYLO LASAGNA LEE LOKI LOUIE LUCAS LUISA MAGGIE (SHIRLEY - Boston Terrier mix) MAPLE MARISOL MARLIN MIA MICHAEL MIDORI MIMI MINKIE MIRANDA MISTY MONTY MURPHY NALA NALA OLIVE OLIVIA OPIE ORCHID OREO OTTO PAULINE PEARL PEPPER PERCY PERRI PHOENIX PIP PISTACHIO POLLITO PRADA QUILT RAIN RAZOR REBA RHEA RILEY ROMEO RORY ROSEMARY RUTH SADIE SALVADOR SASHA SASHA SETH SHEILA SHIESTY SKY SKY SOY SAUCE SPENCER STELLINE SUKI SUNNY SUNNY TARA TESSIE TIG TIGRIS TIMOTHEE TOBY TRU WAFFLES WILLOW YARA aka ROSIE YEOL YODA ZAILEY ZELDA ZUZU
Name of the animal, if you are applying for more than one? Choose an animal: ALEX ALEXANDRA ALICE ALOE ARCHIE ARCHIE ASIA BASHFUL BEE BEE BERT BETHANY BETHANY BILLI BINDI BINKY BISCUIT BISCUIT BLAIR BLOOM BO DUKE BOB BONZI BROWNIE BUSTER CAL CAMOUFLAGE CARAMEL CASHMERE CHAN CHARLIE CHASE B CHEETO CHIBBS CLAIRE CLARIA CLIFTON CLOVE COLTER COLTER DAFFODIL DAISY DUKE DAMIEN DARLA DAWN DELILAH(terrier) DOC DOLLY DOUG DUDLEY DWIGHT EBONY EDWIN ELEANOR ELF ELLE ELLIE ELSA EMMALINE EMMET EVEREST EVIE FELICIA FERGAL aka RAMBO FERN FILLET GAGA GAGA GEMMA GENERIC KITTEN GHOST GILL GIZMO GOOBER GRAVY GRUMPY GUCCI GUS HAPPY HARLEY HAZEL HENRIETTA HERCULES HOLLY HOUDINI IVY JAFAR JAX JR JUDE KALA KAREN KATE KATTIE KEELEY KINGFISHER KORBIN KYLO LASAGNA LEE LOKI LOUIE LUCAS LUISA MAGGIE (SHIRLEY - Boston Terrier mix) MAPLE MARISOL MARLIN MIA MICHAEL MIDORI MIMI MINKIE MIRANDA MISTY MONTY MURPHY NALA NALA OLIVE OLIVIA OPIE ORCHID OREO OTTO PAULINE PEARL PEPPER PERCY PERRI PHOENIX PIP PISTACHIO POLLITO PRADA QUILT RAIN RAZOR REBA RHEA RILEY ROMEO RORY ROSEMARY RUTH SADIE SALVADOR SASHA SASHA SETH SHEILA SHIESTY SKY SKY SOY SAUCE SPENCER STELLINE SUKI SUNNY SUNNY TARA TESSIE TIG TIGRIS TIMOTHEE TOBY TRU WAFFLES WILLOW YARA aka ROSIE YEOL YODA ZAILEY ZELDA ZUZU
If you are applying for a specific animal would you consider another if that one were not available?
If you are not applying for a specific animal please describe the characteristics of the animal 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
Please provide details if allergies are a consideration.
How many cats are part of your family?
How many dogs are part of your family?
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
