IF KNOWN, WHAT IS THE PET’S NAME IN WHICH YOU ARE INTERESTED IN ADOPTING:
What personality traits are you looking for in your new companion?
Why would you like to own the breed you have selected?
***PLEASE COMPLETE THE ENTIRE APPLICATION – DO NOT SKIP QUESTIONS (indicate with N/A if not applicable)
Full Name (required):
Maiden Name or other variations:
Full Name of Spouse/Partner:
Do you live in a:
HouseApartmentDuplexMobile HomeCondoLive with ParentsOther
OwnRentLease to Own
If you rent OR lease - what is your landlord's name and number?
How long have you lived at the above address:
Place of employment:
How long have you been looking for a dog or cat?
How many hours each day will this dog or cat be left alone?
Where do you plan to keep your dog or cat during the day? (check all that apply)
Indoor onlyOutdoor onlyIndoor/OutdoorDog runYardOther
Will pet be crated?
If crated, how many hours per day?
Where will your pet stay at night (be specific)?
How big is your yard?
Is it all fenced in?
Please describe your yard:
GrassPoolLandscapingMulchDeckFence type:Chain linkWoodNo fenceInvisible
How are fence gates secured?
Will fenced yard access be supervised or unsupervised?
If you have no fence, how will you exercise your pet?
Leash walks every dayWill tie out to pottyWill be free to roam (specify where)Will bring to dog park (supervised and leashed with limited interactions with other dogs)Will bring to dog park to play with other dogs (off leash)Other (explain)
Who will be responsible for your pet’s care?
Who will be responsible for this pet’s financial expenses?
How much do you think you will spend on this pet this year?
How many children live with you?
Please list ages of children:
How many children visit you regularly (include ages)?
Do you have any roommates? If so, how many?
Does anyone in your family have a history of a pet allergy? If so, how is it controlled?
What do you know about heartworm/flea prevention?
If animal is a pit bull, is this your first time owning a pit bull?
If animal is a pit bull, of all breeds available why do you want a pit bull?
Have you ever had an animal impounded/picked up by animal control? If yes, please explain:
Was animal reclaimed? (if not, please explain why)
Have you ever sold, surrendered or given away a pet? (If yes, please explain in detail)
Describe pets that YOU or YOUR CURRENT PARTNER (adult who lives with you) have owned in the past ten years (do not include childhood pets or pets owned by your parents). Name and type of dog or cat, Age, Sex, Spayed or Neutered, Kept Inside or Outside, How long owned, What happened to pet (or still have)
If your pet did have a behavior problem, what would you do?
Give to a shelterGive awayPut an ad in the paper to find a new homeAsk a vetCall a trainerTrain yourselfOther
How much time are you willing to give this pet to adjust to its new environment?
his animal may not be housebroken or may be only partly housebroken. Are you willing to take the time to work with him/her?
If yes, how would you react if this pet had a potty accident in the house?
A newly fostered dog or cat may want to spend as much time with his/her new family as possible during their transition into your home (and this is a normal part of the animal-human bonding process). Your new pet may want to sit on the sofa or sleep in bed with you. How do you feel about this?
If your new pet wants to be on your furniture, how will you handle this?
Do you plan to seek obedience training?
Why or why not (will you seek obedience training)?
If pet is a dog, will you crop its ears?
Who is the veterinarian or veterinarians who have provided care for your current and previous pets?
Veterinarian phone number(s) and name on the veterinary account:
How do you feel about spaying/neutering?
When you go on vacation, who will care for your pet?
Why do you want a pet?
CompanionCompanion for other petGiftFamily petHuntingBreedingProtectionFor another personOther
What reasons would cause you to consider giving your adopted pet back, or cause you to no longer be willing to commit to him/her? (check all that apply)
Job change (increased work hours, longer commute time, change of schedule, loss of job/income), career change,or decision to attend/return to collegeLiving situation changes (move to new home, move in with spouse/partner/parents, obtain roommate(s) )You move to an area/home that will not allow your pet or your pet is bannedSomeone in your household develops allergies to your pet(s)You get married, separated, or divorced, or have/adopt a childPet chews on inappropriate items or is destructive when not supervisedPet has housebreaking or crate training problemsPet has behavioral problems such as separation anxiety, etc.Pet does not get along with your current petsPet develops health conditions in the future
1st reference: Name and Phone #
2nd reference: Name and Phone #
How long have you been with this employer?
Is there anything else you would like to tell us or ask us?
Thank you for your interest in adopting and saving a life! Our goal is rescuing animals is to provide them with a loving home for the rest of their lives. Upon receipt of your complicated application, it will be reviewed and we will get back to you within 48 hours. (The adoption fee covers part of the medical costs associated with this animal.)
*Please be aware that this rescue reserves the right to refuse adoption for any reason in the best interest of the dog or cat.
I VERIFY THAT I HAVE ANSWERED ALL OF THE QUESTIONS TRUTHFULLY. I UNDERSTAND IF ANY OF THIS INFORMATION IS FOUND TO BE FALSE, WE MAY CONFISCATE THE ADOPTED ANIMAL. WE RESERVE THE RIGHT TO REFUSE PLACEMENT OF ANY ANIMAL. WE REQUIRE A HOME VISIT AND REQUIRE THAT ALL MEMBERS OF THE FAMILY (INLCUDING OTHER PETS) VISIT WITH THIS ANIMAL PRIOR TO ADOPTION.
Your Signature (type S/Name)
Don’t breed or buy – while homeless animals die! THANK YOU for contacting rescue!