Date Of Birth:*
Animal You're Applying For:*
How Did You Hear About Us?:
Have You Adopted From LMAR Before?:*
Years Employed:
Please List Names and Ages Of All Adults and Children In Home:*
Do You Own Or Rent Your Home?:*
If Rental, Please Provide Landlord's Name and Phone Number:
How Long Have You Lived At Your Current Residence?:*
Type Of Home:*
Type And Height of Fence:
May We Visit Your Home?:*
Any additional Information which helps describe your home environment?:
Primary caregivers work schedule:*
Describe how the pet will be maintained while away or at work.:*
Have you had animals in the last 10 years? If yes, please list, name, alive or dead & how they died:*
Veterinarian References: Name, Address & Phone #
Personal Reference #1: Name, Address & Phone # *
Personal Reference #2: Name, Address & Phone # *
I agree to the following: All statements made on this application are truthful; I have made no false statement with regard to family members in household, references provided - not being family members, status of my home ownership and any other statements made on this application. *