Adoption Application form

Vet Reference: Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNo

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval, I understand that Animal Protection & Education has the right to refuse any request for adoption, and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Animal Protection & Education animal adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release, indemnify, and covenant to hold harmless Animal Protection & Education, and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted animal.

I accept full responsibility for the dog(s) actions at all times, and release Animal Protection & Education from any liabilities or damages that may be incurred because of adopting such animal(s).

I agree to have Animal Protection & Education complete reference call checks and conduct a home visit inspection to be able to approve my adoption application.

I agree that if I'm unable to keep the pet(s) anymore that I will return the pet(s) to Animal Protection & Education and try to give Animal Protection & Education a two (2) week period to try and find a suitable foster for the pet(s).

Date*

MonthDayYear

Your name*

Date of Birth*

Date

E-mail*