Small Animal Adoption Application

I agree that all statements in this application are made based on personal knowledge and are made for purposes of my application to adopt one or more animals from One Life at a Time Animal Rescue, Inc.*

Name of animal(s) you are applying to adopt*

I understand that One Life at a Time Animal Rescue, Inc. is very concerned about the security and safety of my adopted animal and all the animals in its custody, as well as its ability to keep track of all animals rescued. I understand One Life at a Time Animal Rescue, Inc. will not share this information for any reasons not connected to the adoption program or applicable lawsuits. *

Where my animal will sleep at night

Where my animal will sleep during the day when I am home

Where my animal will stay during the day when I am not home

How long will my animal be alone per day

Name*

First NameLast Name

Email*

example@example.com

*Email will be the primary method of communication from One Life at a Time Animal Rescue, Inc., so if you do not check email regularly, please tell us how to best get in touch with you.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Please choose one of the following*

I own my home and am permitted to bring an animal or animals into my dwelling.I rent my home and am permitted to bring an animal or animals into my dwelling.

Length of time at this residence

If you are a renter, please provide your landlords name and phone number below.

Please provide the name and phone number of the veterinarian(s) you use for your animals. If more than one, please list all veterinarians consulted in the last 5 years.*

Please list two references with phone numbers - people who know me (but are not related to me) and my animals*

Number of years' experience with the type of animal you are looking to adopt

How many companion animals are currently in your home*

Please provide details on all companion animals currently residing in your home (name, age, species, gender, and if they are spayed/neutered)

Please provide details for all companion animals you have owned in the last 5 years who are no longer with you and why they are no longer with you.

Please list all members of your household and their ages

Please tell us what type and size of cage you are planning to use for your adopted pet.*

What type bedding do you plan on using?*

Please tell us what diet you plan on feeding your adopted pet.*

What size and type of exercise wheel are you planning to use (if applicable)*

I understand a rescue representative may visit my home for a home inspection before my adoption application is approved.*

I understand that if I am approved for adoption, I will also need to carefully read the “Adoption Agreement,” which is a separate document from this “Adoption Application.” The Adoption Agreement represents the legal contract between an adopter and One Life at a Time Animal Rescue, Inc. I understand that if I am approved to adopt an animal, I must review the Adoption Agreement before I can take my animal home. I further understand that I will be asked to agree to the terms of the Agreement and sign the Agreement before I can take my animal home.*

I have read this Application in its entirety, and I agree that all statements contained in this document are made by me, and are truthful. I make this statement under penalty of perjury under the laws of the State of Pennsylvania.*

Signature

Date