| Name of Primary Caretaker | |
| Address | |
| City, State, Zip | |
| E-mail | |
| Contact Phone | |
| Age of Primary Caretaker | |
Please list the people that currently live at
your residence or visit frequently.
(Please list relationship to you & their age. We
don't need the children's names.) |
|
Does anyone in the household have any known
allergies to animals? |
|
If yes, please explain.
| |
| Does anyone in the household have asthma? |
|
Which of the following best describes your
current residence? |
|
| Do you own or rent? |
|
If you do NOT rent your home, are you the owner
of the home? Who owns the residence? | |
| Are you under home association regulations ? |
|
If so, Weight Limit or Breed Restrictions
| |
Landlord (or Association) Contact Name
| |
Landlord (or Association) Contact Phone
| |
| Do you have a fenced yard? |
|
| Type of Fencing | |
| Fence Height | |
| Type of Gates | |
| Is fence solid & secure? |
|
| Can children open gates? |
|
| Comments on Fencing | |
Please list all current pets. Include all
animals residing with you, even if you do not
own them.
If you do not currently live
with any pets, please describe pets owned in the
past.
List your pets by name, their
species, and breed.
|
|
Are all the above animals current on
vaccinations & heartworm preventative? |
|
| Are they all spayed and/or neutered? |
|
If you answered no above, please explain why
they have not been altered. |
|
What happened to any previous pets that you no
longer own?
|
|
Have you ever had to give up a pet? (For example
had to give away or take to a shelter.)
Please explain why & when.
|
|
| Vet Name | |
| Vet Contact Person | |
| Vet Address | |
| Vet Phone | |
Names of Pets Treated &
Name records are
filed under | |
If you do not have a current vet, who is the vet
you intend to see?
| |
Please provide us with a personal reference, not
related to you.
(Name, address and phone
number and relationship to you) |
|
Please list the name(s) of the animal or animals
you wish to adopt (include breeds and ages if
known).
| |
If the animal you are interested in has already
taken, would you consider another one? |
|
Even if you are applying for a specific animal,
please tell us what kind of pet you want to
adopt... |
|
| How soon are you hoping to adopt? | |
Please provide SPECIFIC information on where the
pet will spend most of its time: |
|
Where will the pet be kept while you are at work
or out on errands? Please provide detail. |
|
Who will care your your pet while you are on
vacation? | |
Do you have a crate? If so, how is it used, how
often is it used, and under what
circumstances?
|
|
Approximately how many hours a day will your new
pet be alone? | |
Are you willing and able to support a pet for
the remainder of their life? |
|
Do you understand that the dog should NEVER be
allowed off lead in open spaces? |
|
Do you agree to a rescue representative visiting
your home prior to & after adoption? |
|
Any other comments you'd like for us to consider
when reviewing your application to adopt: |
|
|
| | |
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