ADOPTION APPLICATION
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We reserve the right to refuse any adoption we consider unsatisfactory.
Omissions or falsified information may result in denial of application.
Your application will be reviewed by the next business day.
All fields with a red asterisk
*
are REQUIRED unless marked as optional.
Adopter Information
Adopter Last Name
*
Adopter First Name
*
Adopter Middle Name
Co-Adopter Last Name
Co-Adopter First Name
Co-Adopter Middle Name
Address
*
Apt/Unit
City
*
State
*
Zip Code
*
Choose type of housing
*
Select...
Own
Rent
Live with Parents
Live on Campus
Other
Other
*
Primary Phone
*
Secondary Phone
Alt. Phone
*
Email
Are you claiming a Public Records Exemption under F.S. 119?
*
Yes
No
If yes, you must provide proof of exemption to Animal Services
*
Do children live in the home?
*
Yes
No
Age of Children
*
0-5 years
6-13 years
14-17 years
Current Pet Information
What are you looking to adopt?
*
Cat/Kitten
Dog
Puppy
Fostering
Animal ID:
A
Please list all pets currently in your household.
Name
Breed
Color
Age
Sex S/N?
Inside/Outside
Is the Rabies vaccine current?
No Pets have been Added
Add Pet
Name of current Veterinarian or Veterinary Clinic?
Where will the pet be housed during the day?
Where will the pet be housed over night?
How will you keep pet confined on your property?
How often do you vaccinate and license your pet?
PLEASE INITIAL THE STATEMENTS BELOW
I understand an inspection of my premises may be conducted by LCDAS.
*
I understand LCDAS reserves the right to refuse any application considered unsatisfactory for any reason.
*
I certify that all the information on this application is true and any false information may void this application.
*
Signature
*
Clear
Submit
Cancel
Add Pet
Name
*
Breed
*
Color
*
Age
*
Sex S/N?
*
Select...
Spayed - Female
Neutered - Male
Unaltered - Female
Unaltered - Male
Inside/Outside
*
Select...
Inside
Outside
Is the Rabies vaccine current?
*
Select...
Yes
No
