First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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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 ALL 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 by name, age, sex and breed*

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 For The Day?*

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/Behaviors 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/Surrender/Give Up An Animal ? If So Why?*

The Average Cost Per Pet For Providing Vet Care Can Range From $150 Up To 500. 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?