Laguna Madre Humane Society P.O. Box 13258 262 Woodys Lane Port Isabel, TX 78578 (956)943-3888 Fax (956)943-1595 www.petsadrift.com Email: lagunamadrehs@hotmail.com ADOPTION APPLICATION GUIDELINES Thank you for taking the time to fill out our questionnaire. The purpose of this Application is to learn a little about your family and home so that our organization can make the best possible match for both you and our rescue animal. Our main concern is placing our animals in a compatible home with a family that will give them a LIFETIME commitment of love and proper care. This consultation process is designed to help us determine if the adoption is in the best interest of both the animal and the adopter. Please be aware that while completing this application does not bind you to adopt one of our animals, neither does it guarantee that we will place one of our animals in your home at this time. If you are interested in learning more about one of our rescue animals, please answer the questions honestly and thoroughly. Please keep in mind that most of the animals that have ended up in our program have been rejected for one reason or another, usually through no fault of their own. This just means that they need some extra time and patience to adjust to yet another new home. Some may need housetraining or other types of training, and some may just need a little extra love and patience. All animals, regardless of their background and history, go through an adjustment period when they go to a new environment. There will be a period of a few days, weeks or in some cases months during which your new pet’s personality is emerging and growing while you get to know one another. In order to help you and your pet get through this transition period as smoothly as possible, we will help you in any way possible. Please remember that this is a stressful time for an animal and hopefully we will be able to work together to make this a lifetime relationship for you and your rescue pet. You can call on us at any time to help you in any way. With this in mind, please answer the questions on the application to the best of your ability. Laguna Madre Humane Society reserves the right to refuse adoption for any reason. A representative of L.M.H.S. may conduct home visits prior to or following an adoption, and L.M.H.S. has the right to reclaim an animal following an adoption if unsuitable home conditions, evidence of neglect, abuse or other mistreatment of the animal are found on said visit. By signing below, you are indicating understanding of and agreement with the above guidelines. You also verify that the information supplied by you on the Adoption Application is accurate and truthful. Should an adoption take place, you also agree to abide by the terms and conditions specified in the Adoption Contract. If you have any questions regarding these stipulations, please discuss them with a L.M.H.S. representative prior to signing. ______________________________________________ __________________ YOUR SIGNATURE DATE _______________________________________________ __________________ L.M.H.S. REPRESENTATIVE DATE Laguna Madre Humane Society P.O. Box 13258 262 Woodys Lane Port Isabel, TX 78578 (956)943-3888 www.lagunamdrehs.org ADOPTION APPLICATION Thank you for choosing a rescue animal! IN ORDER TO BE CONSIDERED AS AN ADOPTER TODAY, YOU MUST: * Be 18 years of age or older. * Have identification showing your present address. * Have the knowledge and consent of your landlord. * Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet for the entire life of that animal. PLEASE FILL OUT THE FORM BELOW NAME:________________________________________________ DATE:_________ ADDRESS:____________________________________________________________ CITY:___________________________________STATE:_______ ZIP:__________ HOME PHONE:__________________________WORK PHONE:____________________ OCCUPATION:_________________________________________________________ EMAIL:______________________________________________________________ DO YOU HAVE ANY CHILDREN? YES _____ NO _____ If yes, how many?____ CHILDREN’S NAMES AND AGES: Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ Name:__________________________Age:_____ DO YOU _____OWN OR _____ RENT? If you rent, what is your landlord’s name?______________________________ Phone Number:_____________________________ (Please keep in mind that we will only verify landlord’s consent if and when you adopt a pet from our program.) DO YOU HAVE A FENCED YARD? YES ______NO ______ If yes, what type of fence?________________________ How high?___________ WHAT PETS DO YOU CURRENTLY HAVE IN YOUR HOUSEHOLD? Type: Name:______________ Age:_____ Dog___ Cat___ Other_____ Altered: Yes___No___ Kept Where? In____Out____ Type: Name:_____________ Age:_____ Dog___ Cat___ Other_____ Altered: Yes___No___ Kept Where? In____Out____ Type: Name:______________ Age:_____ Dog___ Cat___ Other_____ Altered: Yes___No___ Kept Where? In____Out____ Type: Name:_______________ Age:_____ Dog___ Cat___ Other_____ Altered: Yes___No___ Kept Where? In____Out____ LIST THE PETS YOU HAVE OWNED IN THE PAST FIVE YEARS OTHER THAN THOSE ABOVE. TYPE: ALTERED: KEPT WHERE: TIME OWNED: Dog___Cat___ Yes___No___ In____Out____ _____________ WHAT HAPPENED TO THE ANIMAL? TYPE: ALTERED: KEPT WHERE: TIME OWNED: Dog___Cat___ Yes___No___ In____Out____ _____________ WHAT HAPPENED TO THE ANIMAL? TYPE: ALTERED: KEPT WHERE: TIME OWNED: Dog___Cat___ Yes___No___ In____Out____ _____________ WHAT HAPPENED TO THE ANIMAL? TYPE: ALTERED: KEPT WHERE: TIME OWNED: Dog___Cat___ Yes___No___ In____Out____ _____________ WHAT HAPPENED TO THE ANIMAL? WHO IS YOUR VETERINARIAN? Name:_________________________________________________________ Hospital Name:____________________________ Phone Number:_______________ IS THERE A DOG LIMIT IN YOUR CITY/TOWN? YES_____NO_____ If yes, what is the limit? ____ DOES ANYONE IN YOUR HOME HAVE PET ALLERGIES? YES_____ NO______ IS THE WHOLE FAMILY IN AGREEMENT WITH ADOPTING A RESCUE PET? YES____NO____ If no, who isn’t and what are their reasons?______________________________ DOG ADOPTIONS ONLY: DO YOU WANT A DOG FOR: (Check all that apply) House Pet____ Guard Dog____ Companion_____ Gift____ Companion for Other Dog_____ Other (please explain)_____________________ DO YOU REALIZE THAT YOU WILL PROBABLY HAVE TO HOUSETRAIN A NEW PUPPY OR DOG? YES____ NO____ WHAT WILL YOU DO IF YOUR DOG CHEWS FURNITURE OR OTHER BELONGINGS OR SHOWS DESTRUCTIVE BEHAVIOR? ____________________________________________________________________________ ____________________________________________________________________________ HOW WILL YOUR DOG BE CONFINED TO YOUR PROPERTY? (Check all that apply) In House_____ Crate/Kennel_____ Fenced Yard_____ On Chain_____ Garage_____ Patio_____ Other(please explain)__________________________ HOW MUCH EXERCISE DO YOU PLAN ON GIVING YOUR DOG? _____________________ ARE YOU AWARE THAT HEARTWORM PREVENTIVE MUST BE PURCHASED FROM A VETERINARIAN AND ADMINISTERED MONTHLY TO KEEP YOUR DOG HEALTHY? ARE YOU PREPARED FOR THE COST OF $150 TO $200 PER YEAR FOR ANNUAL VACCINES, HEARTWORM PREVENTION AND ROUTINE MAINTENANCE OF YOUR DOG? YES_________ NO__________ CAT ADOPTIONS ONLY: DO YOU WANT A CAT FOR(Check all that apply) House Pet____ Mouser____ Companion_____ Gift_____ Companion for Other Pet_____ Other(Please explain)____________________ WILL THIS CAT BE ALLOWED OUTDOORS? YES______ NO______ DO YOU PLAN TO HAVE THIS CAT DECLAWED? YES______ NO_______ WHAT WILL YOU DO IF YOUR CAT CLAWS THE FURNITURE OR SHOWS DESTRUCTIVE BEHAVIOR? _____________________________________________________________ ARE YOU AWARE THAT ROUTINE MAINTENANCE FOR YOUR CAT INCLUDING VACCINES AND FLEA/TICK PREVENTION WILL COST AN AVERAGE OF $150.00 PER YEAR? YES___________ NO__________ ALL ADOPTIONS: IS THERE A SPECIFIC ANIMAL THAT YOU ARE INTERESTED IN ADOPTING FROM US? NAME_____________________ BREED/TYPE_________________________________ WHY THIS PARTICULAR ANIMAL?___________________________________________ ______________________________________________________________________ IF NO, PLEASE TELL US WHAT YOU ARE LOOKING FOR:_______________________ ______________________________________________________________________ ______________________________________________________________________ WHERE WILL THIS PET BE KEPT DURING THE DAY?___________________________ DURING THE NIGHT?_____________________________________________________ HOW MANY HOURS WILL THIS ANIMAL SPEND ALONE EACH DAY?_________________ HOW LONG DO YOU FEEL AN ANIMAL SHOULD BE GIVEN FOR AN ADJUSTMENT PERIOD? ______________________________________________________________________ ARE YOU WILLING TO WORK WITH A NEW PET ON ANY ISSUES THAT HE/SHE MAY HAVE? YES _______ NO______ (If No, Please Explain )_________________________ ______________________________________________________________________ ______________________________________________________________________ WHAT BEHAVIORS WOULD BE UNACCEPTABLE TO YOU?__________________________ ______________________________________________________________________ ______________________________________________________________________ WHAT ACTIONS WOULD YOU TAKE TO CORRECT THESE BEHAVIORS?_______________ ______________________________________________________________________ ______________________________________________________________________ EXCLUDING YOUR DEATH, WHAT CONDITIONS/CIRCUMSTANCES WOULD CAUSE YOU TO GIVE UP AN ANIMAL? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ARE YOU AWARE THAT IF YOU ADOPT A PET FROM US AND CAN NO LONGER KEEP IT, L.M.H.S. WILL TAKE THE ANIMAL BACK AT ANY TIME AND FOR ANY REASON? YES_____NO______ Thank you for taking the time to answer our questions. We hope that by going through this process, we will reduce the chance of an inappropriate match both for you and for our animals. If you have any comments regarding this adoption application or our adoption process, please feel free to let us know as we are always looking for ways to improve! Again, thank you for considering a rescue pet and saving a life. COMMENTS: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________