2900 US 70 East Clayton, NC 27520
Phone: (919) 550-8400 Fax: (919) 550-8401

The information obtained in this application is used to ensure a good match between you and a prospective pet, as well as ensure a basic quality of life for the pet you are adopting.

Which pet are you interested in adopting?
Your Information:

First Name: Last Name:
Address:
City: State: Zip:
Phone: Phone:
Employer: Work Phone:
Email:

Residence Information:

What type of housing do you live in? Rent Own
If renting, can you provide written permission to own your pet? Yes No
Do you have a fully fenced in yard? Yes No
If you move will you take this pet with you? Yes No
Are there other dogs or cats living at this residence? Yes No
Is anyone in this household allergic to this type of animal? Yes No

Care Information

Where will this pet be housed?
How long will this pet be left alone or attended each day?
Please describe how this pet will be kept while alone or unattended:
Please describe how this pet will be cared for when you are out of town:

Additional Comments:
Adoption Agreement:
I understand the sterilization of this animal is MANDATORY and included in the adoption fee and will cooperate with Lucky Paws to schedule the sterilization of this animal (if not done so already).

I am willing and able to assume the cost for the health and welfare of this animal for a probable lifetime of 10 to 15 years or more. This animal will see a vet on a regular basis for vaccinations, exams, and any emergencies.

I will provide proper and sufficient food, water, and humane treatment for this animal at all times.

As the new owner of this pet, I assume all responsibility for its behavior. If I can no longer keep this pet, I will notify Lucky Paws Rescue and make arrangements to return the pet as soon as possible.

If this animal ever gets lost or stolen, I will contact Lucky Paws Rescue immediately in order for it's safe return.

I certify that all of the above information is correct. I UNDERSTAND and AGREE that if any false statements have been made herein, or if there is any knowledge of abuse or neglect, Lucky Paws Rescue reserves the right to reclaim ownership of this pet.
I have read and agree to the terms of the Adoption Agreement
Your Name: (acts as a signature) Date: