Name
Address
City, State, Zip
Daytime Phone
Evening Phone
Email Address
How long at current address
If less than 3 years, please provide previous address
Your Occupation
Place of Employment
Employer's Phone

 

 

Do you own or rent your current home?	Please Select Own Rent
If you rent, a statement from the landlord with address and phone number is required.
Does anyone in your house have allergies to dogs or cats?
Are there children living in the home?
If yes, how many & ages:
Would you consent to a pre-adoption and post-adoption home visit?	Please Select Yes No

 

 

What pets have you owned before?
What happened to them?
What animals do you now own?
Are they Spayed/Neutered?	Please Select Yes No
Current on Vaccinations?	Please Select Yes No
Do your pets tolerate other animals?
Your Veterinarian's Office Name & Phone #	Name: Phone: No Current Vet
Are you financially prepared to provide the necessary care for your pet including: proper food, vaccinations, parasite control (fleas, ticks, worms, etc.), licensing, adequate shelter, and veterinary care for yearly check-ups, or an after-hours medical emergencies?	Please Select Yes No
Will your pet spend all or most of the daytime indoors?	Please Select Yes No
Will your pet spend all or most of the night indoors?	Please Select Yes No
Are you willing to COMMIT yourself and your energies to this pet for its lifetime?	Please Select Yes No
What do you consider a good reason to give up your pet?
Have you ever used a crate to train a pet?	Please Select Yes No
Any objection to crate training, if needed, i.e. to prevent unwanted behavior [chewing electric cords, furniture]; or health problems that might occur; for further house breaking of a shelter pet; to medicate urinary tract infection, etc.)	Please Select Yes No
Is your yard fenced “dog secure”?	Please Select Yes No
If not, how will you “potty” your dog?
Will outside shelter be needed/available while you are away for short periods?	Please Select Yes No
Have you trained a dog in basic obedience in the past?	Please Select Yes No
If needed for better control, would you be willing to take your dog through a basic obedience class?	Please Select Yes No
About how many daytime hours, per day, will you be able to be at home with your pet?
I am interested in the following type, breed, age, size, and animal

 

  I affirm that all application information is true.

  I realize that this is a lifetime commitment to this animal and I will endeavour to give this pet a happy & healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTER FOR ASSISTANCE, OR IF I MUST EVER GIVE IT UP, I WILL RETURN IT TO MY ADOPTER.

  I agree to allow Adopt-A-Rescued Pet, Inc. to do a home visit prior to adoption, and as a follow up, if needed, to investigate the premises where the animal is kept, and to reclaim the animal, if in the judgment of Adopt -A- Rescued Pet, Inc, the animal is not being adequately cared for, the terms and conditions of this adoption contract have not