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Please fill out this application to your fullest knowledge. Missing information may result in your application being denied. Please understand that we are a volunteer run organization, and it may take us up to three days to process your application. If you do not hear from us within that time span, please email us at email@example.com. Please speak with all the members of your household prior to filling out this application. Failure to do so may result in your application being denied.
Name(s) of the animal(s) you are interested in:
Enter name of the animal that you wish to adopt
Address Line 2
State / Province / Region
ZIP / Postal Code
Antigua and Barbuda
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Congo, Democratic Republic of the
Congo, Republic of the
French Southern Territories
Heard and McDonald Islands
Isle of Man
Lao People's Democratic Republic
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Svalbard and Jan Mayen Islands
Trinidad and Tobago
Turks and Caicos Islands
US Minor Outlying Islands
United Arab Emirates
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Do you rent or own your home?
Please provide your landlord's name and phone number
Is your yard fenced? Please describe
How many adults reside in your home?
How many children reside in your home? What ages?
Do you have kids?
How many kids and what ages
Are you expecting children in the near future?
Do you have any dogs or cats in your home?
Please list the names, ages and breeds of the animals
Are your pets all spayed and neutered? If not, please explain
Are your pets up-to-date with rabies and distemper vaccinations? If not, please explain
What vet do you currently use?
Please provide phone number and who is the name on records
If you do not have a vet, who do you plan to use?
Have you ever had to give up a pet before? If yes, please explain
What behaviors of your current pets frustrate you?
What is your favorite behavior of your current pets?
Have you rescued a pet before? If so, from where?
Why are you interested in this particular pet?
How do you plan on disciplining your pet?
Where will the pet sleep at night?
Where will your pet be kept when you are not home?
Do you plan on keeping the pet indoors or outdoors?
What brand of food will you feed your pet?
What type of physical activities do you plan on doing with your pet?
Who will be responsible for the daily care of your pet?
Would you be willing to take your pet to a obedience class?
Every pet needs time to adjust to a new surrounding. Some adjust very quickly while some can take up to a couple months. Are you willing to give your pet the appropriate time to warm up to you and your family?
Please list 2 references. Include name and number
I agree to Lucky Paws Midwest policies
I hereby certify that all information provided herein is true and that I have answered all questions honestly. I further certify that I am at least 18 years of age. I understand that providing false information will result in the application being denied. I understand that Lucky Paws Midwest reserves the right to deny any application for any reason for the sake of protecting the welfare of the animal. I understand that this application is subject to the approval of the Lucky Paws Midwest’s Adoption Committee. I further understand that I will be notified of an approval or denial within 3 days of the completion of this application. If my application is denied, I understand that Lucky Paws Midwest may or may not disclose the determining factors which led to the final decision.
I understand that I have only submitted an application to adopt and this is not an adoption contract, and that approval is not guaranteed.
It is my intention to integrate the animal that I am applying to adopt into my home and life as a pet, companion, and member of my family. I understand that the adoption of any pet is a commitment to provide love, shelter, and care to him/her for the duration of his/her life. I certify here that I am ready to make this commitment with the full knowledge that my pet may exceed 15 years of age. I am prepared to be financially responsible for veterinary care including, but not limited to, annual check ups and vaccinations. I am prepared to provide grooming, exercise, and social interaction for the pet.
I hereby authorize Lucky Paws Midwest to contact my references as a part of the screening process for adoption, and agree that Lucky Paws Midwest will only use this information for adoption purposes.