Adoption Application

LAKE COUNTY SHERIFF'S OFFICE ANIMAL CONTROL
ADOPTION APPLICATION

Thank you for considering the adoption of an animal from Lake County Animal Control (LCAC). In order to best serve you, and match the needs of the animal with a potential new owner, we ask that you take a moment to complete the application below. LCAC will be contacting your references to ensure that the adopted animal will be taken care of responsibly. We reserve the right to accept or deny your application based on the information you provide. If you have any questions, please ask before completing the application.
Date:*

MonthDayYear
Date
Name: (Please provide your legal given name)*

First NameMiddle NameLast Name
Birth Date: *

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County you reside in: *
Example: Lake County, Mason County, Osceola County, etc.
Phone Number:*

Area CodePhone Number
Email:*
example@example.com
Name/Description of Animal you are interested in: *
Ex: Molly, Black Lab
1. How many dogs do you currently own? *
1.A. Please list dog's name(s):
2. How many cats do you currently own?*
2.A. Please list cat's name(s):
3. Are all dogs or cats in the house spayed or neutered? (Check all that apply).*

YES - all animals are spayed or neutered.NO - all animals are not spayed or neutered.SOME - some of the animals are spayed or neutered, while some are not.OTHER - I choose not to spay or neuter my animals.OTHER - (Explain in Box #4).I currently do not own any animals.
4. Please explain your OTHER selection from Box #3.
5. Are all DOGS currently rabies vaccinated and licensed yearly?*

Yes - All dogs are up to date on rabies vaccination and licensing.No - All dogs are not up to date on rabies vaccination or licensing.No - My dog is currently too young to be rabies vaccinated or licensed.Other - Please explain in Box #6.I currently do not own a dog.
6. Please explain your OTHER selection from Box #5.
7. Who issues your dog license?*

County Animal ControlCounty Court House / Treasurer's Office.Veterinarian's Office.Unsure.I do not currently own a dog.
8. May we contact your veterinarian for a reference?*

YesNoI do not have a veterinarian.
9. Please list your current Veterinarian's Name & Phone Number. (Please call your veterinarian to notify them we will be calling). *
Please list the Veterinarian(s) that you have taken your animal to for spay/neuter and vaccinations. Please put none if this does not apply to you.
10. Do you plan to spay / neuter ("fix") the animal you are submitting the adoption application for?*

YesNo
11. Where will the adopted pet spend most of it's time?*

InsideOutsideBoth
12. What method of containment do you plan to use for your new pet? Mark all that apply. (DOG APPLICATIONS ONLY).*

CrateCable Tie OutOutside KennelChain with Dog HouseFenced in YardElectric FencingMARK HERE FOR CAT APPLICATION
13. Is this pet a gift?*

YesYes, adults/parents have discussed, kids do not know.No
14. Have you adopted from Lake County Animal Control before?*

YesNo
15. When would you be able to come in to meet & greet or to adopt animal? (MEET & GREETS REQUIRED FOR OTHER DOGS).*
Housing Questions
1. What is your housing situation? (Check all that apply).*

RentLeaseOwnOther
2. Do you run a daycare business out of your home?*

YesNo
3. Are you allowed to have pets are your current residence?*

YesNo.
4. If renting or leasing, please provide your landlord's or property management's name and phone number: *
Please put none, if this question does not apply to you.
5. Please List Names & Ages of people living in the home: *
Certifications, Authorizations, Releases and Understandings:

1. I certify that all statements on this adoption application are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being allowed to adopt from Lake County Animal Control (LCAC).

2. I certify that I am an adult over the age of eighteen years old and am mentally capable to make decisions on my own.

3. I authorize Lake County Animal Control (LCAC) to contact my veterinarian(s) and anyone else LCAC deems necessary to confirm how I haved cared for my companion animals and/or how I am likely to care for any companion animal(s) I adopt for LCAC.

4. I authorize Lake County Animal Control (LCAC) to contact my landlord or property management to obtain lease information regarding to animal's being allowed at my residence.

5. I undestand that LCAC reserves the right to refuse an adoption.

6. I understand that LCAC and agents of LCAC will keep this information confidential and will be used for the sole purpose of potential adoption.

7. I understand that LCAC adopts animals on a first come, first serve basis.

8. I understand that, with proper care, dogs and cats can live 15 years or more and I am prepared to commit myself to the long-term care and protection of any animal I may adopt from Lake County Animal Control.

9. I understand and agree that Lake County Animal Control will only allow TWO days following my application submission for a response from me in reference to my application. After these TWO days are over, I acknowledge that Lake County Animal Control will pursue other adopters and/or transfers.
Signed (Full Name) *
Date*

MonthDayYear
Date
Should be Empty:

LAKE COUNTY SHERIFF'S OFFICE ANIMAL CONTROL

ADOPTION APPLICATION

Housing Questions