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Full Name:
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Phone Number:
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E-mail Address:
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Home Address:
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City:
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State:
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Zip Code:
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Date of Birth:
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Occupation:
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Work Phone:
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Employer:
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Marital Status:
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Do you have any Children:
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If you have children, how many and what ages are they?:
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Are there any other individuals living in the same household? Names and ages:
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Does anyone have allergies or asthma that would be aggravated by a pet?:
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Have you ever owned a pet before? What kind?:
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What happened to your previous pet(s):
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Are there any other pets? Type, Breed, Age, Gender:
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Are any of your pets current on their vaccinations? If not, why not?:
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Are any of your pets spayed/neutered? If not, why?:
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Name and phone number of your past or present veterinarian:
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typing your name and phone number in the box to the right you are
agreeing to have all of your pets veterinary records released to Lost
But Loved (L.B.L.) Animal Rescue either by phone, fax, or e-mail so
that we can process your adoption application.
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| Do you rent or own? If renting, name and number of your landlord: |
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Where will the cat stay during the day and at night?:
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| Do you travel or go out of town a lot? If so what do you plan on doing with your animals while you are away?: |
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Have you discussed adopting a pet with your family? Is everyone in agreement about adopting?:
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Would you have the cat declawed?:
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Name of cat(s) your are interested in:
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| Have you ever been charged with cruelty to animals or been in jail before? If so please explain: |
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| Would you be OK with LBL Animal Rescue running a background check to make sure that all of the above information given is correct?: |
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Signature:
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Date:
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