Adoption Application

Little Rock Animal Village

Animal you are interested in adopting
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Zip Code *
Cell Phone Number *
Home Phone Number Please use the following format 248-555-1212
Work Telephone Number
Email Address * Please enter correctly as this is the main way we will contact you
Age *
Drivers License No. *
Employer
Occupation
Number of Adults in Household *
Number of Children Under 7
Number of Children Over 7
Number of Dogs in Household *
Number of Cats
Other Animals
Do you live in the City of Little Rock? *
Does your pet(s) have a city license?
Have your pet(s) been vaccinated for rabies?
Do you own or rent your home?
Please select your current residence type.
Does your landlord and lease allow pets?
Does your landlord and lease allow pets?
Is a pet security deposit required?
Is a pet security deposit required?
Has the pet security deposit been paid?
Has the pet security deposit been paid?
What is the purpose for the adoption? (Companion, Guard Dog, etc.) *
Pet for Elderly or Disabled?
Have you ever adopted from the Little Rock Animal Village in the past? (If Yes, provide date) *
Do you have the financial means and are you willing to provide food, shelter, medical treatment, vaccinations, city license, and companionship for your new pet?
Will you provide heartworm preventative for your animal?
Do you agree a dog shall not be chained, tied, or staked to a fixed object?
Do you object to confinement laws, requiring animals not be allowed to run loose?
What behaviors would you not tolerate in your animal? *
Do you agree NOT to train, teach, or encourage aggressive behavior?
Do you agree to refrain from abuse or treatment that is inhumane of your adopted animal?
Do you agree to perform proper grooming and brushing as needed to insure a healthy coat?
Do you agree that your adoptive dog will at all time wear a collar or harness with identification including a city license, if applicable?
State Law requires all animals adopted from the Little Rock Animal Village must be spayed or neutered. Do you object to this requirement?
Unsterilized Animals: If the animal you choose to adopt is too young or medically compromised and is released with a sterilization waiver, it is a requirement that the animal is returned to the Little Rock Animal Village by its fourth month of age or when it is no longer at risk. This waiver is a release to go home but not a release of ownership. The animal will be property of the City of Little Rock until it is spayed or neutered. When the appointment is scheduled, staff has committed its day to the sterilization of the animal and if the animal does not come in on the date scheduled without prior (5 days) notice, an additional $45.00 will have to be paid because of the loss of time. Failure to bring the animal in for its sterilization will result in a citation and seizure warrant retrieving the animal.
Do you understand and agree with the statement of sterilization above?
By typing my initials, I agree with the contract to return the dog on the date given for sterilization. *
How or from whom did you find out about the Little Rock Animal Village?
Do you know about the volunteer opportunities at the Little Rock Animal Village?
Would you like to be contacted or emailed about volunteer opportunities at the Little Rock Animal Village?
Do you agree that if in the future you cannot provide the animal with the proper care that you will return it to the Little Rock Animal Services?
General Agreement: By typing my signature below, I understand and agree to the following items: 1. I authorize Little Rock Animal Services to seize this animal if I fail to have the animal sterilized in the date set. (If applicable) 2. I agree to provide my animal with a proper house, a healthy supply of food, and fresh water at all times. 3. I understand failure to provide the appropriate answers could result in the adoption being denied. I certify that the information I have given on this Adoption Application is true and correct. I am not less than eighteen (18) years of age. I have read and fully understand the conditions of the adoption application. If the Little Rock Animal Services’ staff approves me to adopt an animal, I agree to all the conditions set out in this document.
Type Full Name *
Attach picture of driver's license or other official ID *

Check all entries for accuracy, then press the "Submit" button ONLY ONCE. If you do not receive a confirmation email after you hit Submit, please re-submit your application.