Applicant's full name:

Applicant's home address including street, city, state and zip code:

Applicant's home phone number:

Applicant's cell phone number:

Applicant's date of birth:

Spouse's name:

Best time to call:

Applicant's e-mail address:

Name of applicant's current veterinarian: If you do not currently have a pet veterinarian, then list the name of the vet you previously used.

Veterinarian's phone number including address:

Will you give your veterinarian your permission to speak with us and provide information about your pets past and present? If not, this WILL SURPRESS YOUR APPLICATION.

Why do you want to bring a new pet into your home?

Is everyone in your household in agreement on adopting a pet?

How did you find out about the pet your are interested in adopting?

Have you had pets in the past?

What type of pet(s) did you have in the past?

What brand of dog food did you feed your past pets?

What brand of dog food are you going to feed your new pet?

How many years did you own the pet(s)?

Reason for no longer owning the pet(s)

Do you have any pet(s) currently? List names, type, breed, age & sex.

Has any pets of yours ever gotten lost? If yes, please provide explanation.

Has any pets of yours ever been poisoned? If yes, please provide explanation.

Has any pet of your ever been killed by a vehicle? If yes, please provide explanation.

Would you allow a dog to ride loose in the bed of a truck?

What were the circumstances of your last pet's death?

Would you leave a pet unattended in the yard?

Do you have any other animals? List type, age, gender, and quantity.

Are your current pets spayed/neutered? If not, please explain.

Are your current dogs on heart worm preventative medication? If yes, what brand name? If not, why?

Do you have children at home? If so, specify number of children, gender and ages.

Do you live in a house, apartment, condominium, or trailer?

Do you rent or own?

Note: If you rent, you must provide a notarized letter from your landlord stating that you are allowed to keep a pet in the apartment.

Do you have a yard and is it completely fenced in?

 

If your yard is fenced, what type of fencing do you have and how tall is it?

Do you have a swimming pool in your yard?

If you have a swimming pool, is it totally enclosed by fencing? What type of fencing is it?

Where do you plan on keeping your pet during the day when you are not home?

 

Do you plan on keeping your dog outdoors with a dog house?

What provisions will be made for your pet when no one is home during the day?

What provisions will be made for your pet when no one is home during the evening?

What provisions will be made for your pet when you go on vacation?

How many hours will the pet be left alone each day or evening?

Are you going to crate your dog?

Specify if you have a gender and breed preference for the pet you want to adopt.

Specify if you have a color preference for the pet you want to adopt.

How long have you been looking for a pet?

Where have you looked for a pet prior to contacting us?

Do any members of your household fear animals? Please specify details.

Have any of your past or current dogs ever bitten anyone? Please elaborate.

Will you assume all financial responsibilities for the pet you adopt, including inoculations, spay/neuter veterinary care, quality food, licensing, etc.?

When is the best time for us to arrange a home check visit with you prior to adoption?

Are you planning to change residence in the near future? Please specify details.

Is anyone in your home allergic to animals? Please specify details.

Are you familiar with the animal laws and regulations in your area?

 

And does your city or town have any breed specific legislation laws in effect?

What is your general impression of "Pit Bulls"?

What is your general impression of "Other breeds"?

Is the pet for which you are applying going to be a gift? For whom? Are they aware?

Do you understand that pets you adopt from us need to be spayed/neutered, inoculated and heart worm tested within 30 days of your adoption?

Please note that this will be followed up.

If we recommend that you take your dog to obedience lessons will you do so?

Please provide us with two references that have been to your home.

 

Are you aware this contract states that if for some reason you can not keep the pet you must contact us first and not place the animal at any other shelter?

By signing below, I further certify that the information I have provided on this form is true, correct and accurate. Yes or No

I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption and or adoption agreements between the applicant and rescue Yes or No

Signature:

Date:

 

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