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31
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1
Today's Date
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2
Full Name
*
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3
Full Address
*
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4
Home or Cell Phone #
*
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5
Email
*
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6
You Live In
*
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Please Select
A House
An Apartment
A Condo
We Rent
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Please Select
A House
An Apartment
A Condo
We Rent
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7
Landlords Name & Phone # if you Rent
*
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8
Everyone in household agrees to adopting an animal?
*
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Yes
No
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9
Number of Children in Home
Please Select
0
1
2
3
4
5
6 or more
Please Select
Please Select
0
1
2
3
4
5
6 or more
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10
Age of Children
*
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11
Interested In Adopting
*
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Please Select
Cat
Kitten
Dog
Puppy
Please Select
Please Select
Cat
Kitten
Dog
Puppy
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12
Name of Animal
*
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13
Sex
*
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Please Select
Male
Female
Either
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Please Select
Male
Female
Either
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14
Energy
*
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Please Select
Low
Medium
High
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Please Select
Low
Medium
High
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15
Age
*
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Please Select
0-4 Months
4-6 Months
6-12 Months
1 Years
2-4 Years
5 Years
5 Years or Older
Please Select
Please Select
0-4 Months
4-6 Months
6-12 Months
1 Years
2-4 Years
5 Years
5 Years or Older
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16
Breed
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17
Behavior Traits to Avoid
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18
Who is cat for
*
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19
Please specify Other Animals You Currently Own
*
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Cat or Dog, Name, Age,
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20
Have you had cats or dogs before?
*
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Cats
Dogs
Both
None
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21
What happened to last Pets
*
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22
Hours Pet will be Alone
*
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23
Vet's Name
*
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24
Vet's Phone #
*
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25
Provide a Reference that is not Family
*
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Full Name & Phone # (family or friend)
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26
Provide a Reference that is Family or Friend
*
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Full Name & Phone # (family or friend)
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27
*
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Yes
No
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28
ALMOST HOME RESERVES THE RIGHT TO REFUSE AN ADOPTION
*
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agree
disagree
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29
I / We Agree That If We Adopt A Dog or Cat, We Will Provide Professional Vet Care, A Nutritious Diet, & A Loving Home
*
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agree
disagree
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30
I / We Agree That We Will Return The Dog or Cat to Almost Home Animal Rescue If We Can No Longer Keep It
*
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agree
disagree
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31
No Member Of Our Household Has Ever Been Convicted of Cruelty To Animals
*
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agree
disagree
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