First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County
Email*
Home Phone
Cell Phone
Alt Email
Who Is Your Current Employer And Their Contact Info?:*
Animal(s) Applying For:
What Kind Of Housing Do You Live In:
Rent Or Own?
Landlord Or Home Owner Association Contact Info:
How Long Have You Lived Here:*
List People In Household & Ages: *
Is Everyone In Home In Agreement Of Adopting?:*
Who Will Be Responsible For The Animal?: *
Do You Have A Fenced Yard?: *
What Type Of Fence Do You Have:
How Tall Is Your Fence:
If You Have No Fence How Do You Plan To Keep The Animal In The Yard?:
Do You Currently Have Animals? Please list
Are Your Current Animals All Spayed Or Neutered, If Not Please Explain:
Are You Current Animals Current On Vaccines, If Not Please Explain:
Are Your Current Dogs On Heartworm Preventative? And How Many Months Of The Year?:
How Often Do Your Current Animals Visit The Vet?:
Have You Owned Animals In The Past, Please List:
How Long Did You Own Each Past Animal?:
How Long Has It Been Since The Pet Has Been With You, And Why Not With You Anymore:
Were The Pets Spayed And Neutered? If Not. Why?:
Were Pets Current On Vaccines?:
Were Past Dogs On Heartworm Prevention?:
Please List Vet Name and Contact Info (Please contact your vet and give permission to release info to us):
You Reason For Wanting To Adopt This Pet?
How Much Time Do Your Current/Past Pets Spend Outside?:
How Much Time Would Your New Pet Spend Outside?:
What Is The Longest Amount Of Time The Pet Will Be Left Alone?:
Where Will The Animal Be Kept When You Away:
Rescue Animals Require Time To Adjust To Their New Environment, What Amount Of TIme Do You Consider To Be Reasonable For Adjustment?:
What May Cause You To Give An Animal Up, What Traits Are You Not Willing To Tolerate(Barking, Chewing, Pottying Inside, Etc):
If adopting a cat/kitten, do you plan to declaw?
Methods Planned To Use To Discourage Unwanted Behaviors:
Have You Ever Had To Return An Animal Or Surrender To A Rescue/Shelter? If So Why?
The Average Cost Per Pet For Providing Vet Care Can Range From $150 Up To 300. Additionally There Are Expenses For Food, Toys, Grooming, Boarding, Emergency Vet Care, Ect, Does You Household Budget Allow You To Comfortably Cover These Expenses?:
What Arrangements Have You Made To Care For The Pet In Case You Can No Longer Do So?: *
Would You Object To Someone From The Rescue Coming/Calling To Your Home To Check On The Adopted Animal? *
If You Are Adopting A Puppy, How Do You Plan to Potty Train?:
If Adopting A Puppy, What Are Your Plans To Train The Pup To Have Good Manners?
If Adopting A Puppy, How Do You Plan To Contain The Puppy When Your Gone?
Anything Else You Would Like Us To Know?
