Adoption Application

Fields marked with an asterisk (*) are required.

First name *

Last name *

Email *

Animal I.D. / Name *

Driver's License or I.D. Number *

Daytime Phone Number *

Physical Address *

City *

State *

Zip Code *

Do yoU own, rent ot live with family?

Landlord's name? (if Renting )

Landlord's Phone Number (if renting)

Do you have a private yard? yes or no.

Where will this pet be kept during the day? *

During the night? *

Are there other people living in the household?

Is anyone in your household allergic to animals?

Have you ever adopted a pet from the Lafourche Parish Animal Shelter before? *

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

Tell us about any pets you currently have. Be sure to include each pet's name, type of animal, name of the pet's vet clinic and responsible party (whose name is on the chart 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. *

Yes, I agree

Thank you! Your submission has been received!

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