Animal's Name/ID:

Applicant's Name:

Email:

Driver's License or ID#:

Daytime Phone:

Physical Address:

City, State, Zip:

Do you...

Landlord's Name:
**(if renting)

Landlord's Phone Number:
**(if renting)

Do you have a private yard?

Where will this pet be kept?

Are there other people living in the household?

Is anyone in your household allergic to animals?

Have you ever adopted from LPAS before?

If so, where is/are the pet(s) now?

Have you ever surrendered any of your pets to any animal shelter?

Pet History

List all pets currently residing in your household:

Animal's Name:

Type of Animal:

Animal's Vet Clinic:

Animal's Name:

Type of Animal:

Animal's Vet Clinic:

Animal's Name:

Type of Animal:

Animal's Vet Clinic:

Animal's Name:

Type of Animal:

Animal's Vet Clinic:

Animal's Name:

Type of Animal:

Animal's Vet Clinic:

Responsible Party:
(Whose name is the chart under at the vet?)

Application Agreement Terms

I understand that the Lafourche Parish Animal Shelter (LPAS) can void this agreement if this application contains any false or misleading information. By checking the agreement box, I am giving my consent for the LPAS to perform a vet reference check on any of my animals. I hereby accept the terms of the LPAS Adoption Agreement. I understand that completion of this application does not guarantee that I will be allowed to adopt and that LPAS Staff reserve the right to refuse adoption to anyone.