Animal Adoption Application Katie's Lane Animal Rehab and Rescue

Animal Adoption Application

Katie's Lane Animal Rehab and Rescue

7681 Old River Road

Rockford, Il.

Ph# 312-519-5569

EIN# 84-3147196
Are you interested in adopting a cat/kitten or dog/puppy? Name if available___________*
Your name*
First & Last Name
Your Address*

Street Address

Street Address Line 2

CityState

Zip Code
Your Email*
example@example.com
Your Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Please list any pets currently living in your home, their aged and if they are fixed, vaccinated (including rabies shot) and microchipped.
Please list any other dogs or cats you have had in the past 10 years.

Where are they now?

Have you ever surrendered a dog or cat to a county shelter (kill shelter) or to a humane society or animal rescue?

If so, why?
Vet reference (please call your vet and give notice that we will call. If you have not been to a vet before, please register with one soon.)*
Vet name, address & phone number
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
When will you be ready to adopt this animal?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researching
Is anyone in your home allergic to the animal you're planning to adopt?*

YesNoYes, but it is tolerable for them and they are OK with it.
Are you familiar with the breed?*

YesNo
If you answered no to the question above, please visit Google and do a bit of research so you can be prepared for your new family member!
You live in a:*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
If you rent, you must give the rescue a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations. Or you can provide the landlords name and number and our rescue will call to verify that you are allowed to have pets and which kind at the rental property.

If you live in a condo or townhome, you must show us written proof that you are allowed to have this type of animal there and show any restrictions.
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
Please be aware that dogs/cats given as gifts for the holiday season are usually returned to shelters or given to pounds after the New Year's. With this in mind, please make sure that any animal you are adopting will be a permenant resident.
If applicable, will your children be taught how to play gently and kindly with this animal?*

YesNoNo children
Vet bills can be expensive. How do you plan on paying them? (IE: Pet health insurance)*
Additional reference (if desired)
Do you have any additional comments, questions or concerns?*
By checking the box below, you understand the terms of this form and adoptee. You hereby agree that you will not use this animal in any sort of fighting, breeding, or cruelty. You will love and care for this animal for the rest of its life, and you are ready to commit to that. You also agree, that if for any circumstances you can no longer provide love and care for this animal, you will contact Katie's Lane Animal Rehab and Rescue.

I understand the above, and have tried to the best of my knowledge to make sure all information is correct.
Adopter's Signature*
Signature date*
Thank you for taking the time to submit this form. Please feel free to contact me (the person you are adopting from) or any of the admins in the Adopt/Rehome network. After you click the Submit, you will be redirected to the main page, and you will also recieve a confirmation email. Thank you!
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