1. AdoptionApplication
P.O. Box 825, Youngsville, LA 70592
Allyson: 337-654-0804 •Tasha: 337-247-2778
Email: RoyalCanineRescue@yahoo.com
Website: www.facebook.com/RoyalCanineRescue
Completion of this application does not guarantee adoption approval.Please
take time to accurately complete the application. When completing application in
Word, please double click checked boxes. Thank you!
Applicant Information Date:
Name of Applicant: Age:
Address:
City: State: ZIP Code:
Home/Cell Phone: Driver’s License #:
Email: Birthday:
Spouse’s Name: Spouse’s Age:
Household& ResidenceInformation*If you are not the property owner, RCR will verify your residence’s current pet policy.
Names and Ages of Adults Living at Residence:
Names and Ages of Minors Living at Residence:
Do you or any of your family members have any known allergies to dogs? Yes No
Residence: House Condo Apartment Mobile Home
Do you: Own Rent Rent to Own
If Rent, do you have permission from your landlord to have a dog? Yes No
Name of Landlord: Phone Number:
Is your yard completely fenced? Yes No
If yes, what type of fence?
If not, how will you confine the dog to your property?
Have you ever given an animal away or relinquished an animal to a shelter? Yes No
If yes, what were the circumstances?
Animal Care Plan
Pet will be: Indoor Indoor/Outdoor Outdoor
Is everyone living in the home in agreement about adopting and caring for this animal? Yes No
Do you understand the costs, challenges and care required for an animal that may live up to or more than 20 years?
Yes No
Please list all of the animals you currently own:
Name Breed Age Sex Altered
Name of practice/doctor:
City: State:
Check which applies: Currently looking for a veterinarian
This is my current veterinarian This is the vet that I plan to use.
Updated: 3/8/2013– Version 002 Page 1