Name of Pet YOU ARE INTERESTED IN ADOPTING (required)

Why did you choose this particular pet?

Name

Address

City

State

Zip

Home Phone

Alternate Phone

Email? (required)

Please note, there are no right or wrong answers to any of the questions below, it only helps us confirm the perfect
match for our rescued pets. There are great dogs & cats perfect for every situation.

Occupation

How long would the animal be left alone on a typical day?

Where will this dog be kept during most of the day when you aren’t at home?

Do you have a fenced in yard?  Yes No

If no, how do you plan on exercising and keeping this pet safe while outside?

How long have you lived at your current address?

Rent or Own?  Rent Own

Do you currently live in:

If you rent, does your landlord allow pets?  Yes No

*Before adoption, we need a document from landlord stating you have permission to have a PET.
If you rent, please give name and phone number of landlord for verification purposes:

If you own, whose name is the deed under and what county do you live in?

Are you a:

What is your source of income?

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Please list three personal references (name and phone number)

Have you ever adopted a pet from this or another rescue group/shelter?  Yes No

If yes, please give name & location of rescue group:

How many pets do you currently have in your household?

What veterinarian do you use for these pets? Name, city, phone number, and what name the account is under at
the vet.

Would the Vets listed on this application have records for all the pets listed?  Yes No

Is it ok if we call the vet(s) for verification of records?  Yes No

Please give the following information about pets you currently have and have had in the past 5 years, or any
other animals that live in the household (Please be specific with name of pet, sex, age and breed):

*Are your current pets up to date on rabies vaccinations, booster shots, yearly exams, etc?  Yes No

If not, explain why:

*Are you current pets spayed or neutered?  Yes No

If not, explain why:

If you have more than four pets describe briefly:

How many people are living in your household?

Please give ages and sexes of any children:

Do ALL of the adults in the household share in this decision to adopt this pet?  Yes No

Are you planning on giving this pet to someone as a gift?  Yes No

If this pet is a gift, will the pet continue to live in your current home, or be living elsewhere, explain:

Who will have primary responsibility for the pet?

What best describes your lifestyle:

Do you plan to keep this as a(n)

What methods of training would you use to deter unwanted behaviors?

If you are adopting a cat, do you plan to have it declawed?  Yes No

Do you or anyone living in your household have any known allergies to PETS?  Yes No

If yes, please describe how you will handle that:

If you have other PETS, how will you introduce the new PET?

If you are getting this “for the kids”, have you considered when the kids grow up, leave home, develop other
interests, etc., will YOU still want this PET then?

 Yes No

What might you do if you had to move somewhere that did not allow PETS?

How much do you think you would spend monthly on vet care, food, grooming, boarding, etc.?

How long have you been considering this idea of getting a NEW PET?

ADOPTION IS A LIFELONG COMMITMENT TO THIS PET!! ARE YOU READY?

 Yes No

I hereby certify that the statements I have made in this application are true and complete. I understand that false
or misleading statements can terminate the adoption process.
*I understand this is just an application, NOT a contract, and there is no implied promise that this PET will be
mine just by completing this form.


SIGNED (initials)