Application Form
Requirements
Must be 21 years of age and have a valid form of photo ID
Date
-
Month
-
Day
Year
Have you ever applied for a Petmatchmaker Rescue South animal before?
Yes
No
What are you Applying for?
Name of the Animal you are interested in
*
Alternate Choice
Personal Information
Applicant's Name
*
First Name
Last Name
Co-Applicant's Name
First Name
Last Name
Relationship to Co-Applicant
Spouse/Partner
Parent
Roommate
Other
If Other, please explain
Are you 21 or older?
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
State
Postcode
Applicant's Phone Number
*
-
Area Code
Phone Number
Applicant's Email Address
*
Co-Applicant's Phone Number
-
Area Code
Phone Number
Co-Applicant's Email Address
example@example.com
Employer Name/Occupation or Retired?
*
Household Information
Do you own your home or rent?
*
Own
Rent
Live with parents and they own the home
Live with parents and they rent the home
Type of Home?
*
Single Family
Multi Family
Condo
Apartment
Mobile/Modular
RV/Alternative Home
If you rent, do you have permission for an animal?
Yes
No
I have applied and am waiting on approval
Landlord’s Name
First Name
Last Name
Landlord’s Phone
-
Area Code
Phone Number
Please list every member of the Household, including YOURSELF and all CHILDREN.
Are all members of household in agreement with adopting an animal?
*
Yes
No
To the best of your knowledge, does anyone in the household have any allergies to dogs/cats?
*
Yes, Just Dogs
Yes, Just Cats
Yes, Both
No
May we do a home visit?
*
Yes
No
Is your yard fenced?
*
Fully Fenced
Partially Fenced
Invisible Fence
No Fence
Do you have a pool?
*
Yes
No
How many hours a day are you away from the home and your pet will be alone?
*
2-4
5-9
10+
Do not work/retired/work from home
Do you have someone who can take care of your pet while you are at work?
*
Yes, Friend or Family Member
Yes, Pet Service
Yes, Will attend Daycare Center
No
Do not work/retired/work from home
Do you have a plan for your dog/cat when you go on vacation, travel or away for long periods of time?
*
Friend/Family Member will watch the animal
Animal will board at a vet, kennel or pet resort
Other
Cats only - Where will the cat be kept
Indoor/enclosed catio only
Outdoor/Indoors at night
Indoor/Outdoors free access
Pet Owner Information
Do you currently have pets?
*
Pet Name(s), Age, Breed, Gender
Pet Name(s), Age, Breed, Gender
Pet Name(s), Age, Breed, Gender
Pet Name(s), Age, Breed, Gender
Pet Name(s), Age, Breed, Gender
Have you lost a pet recently? If yes, please explain what happened.
*
Have you ever given a pet away? If yes, please explain what why.
*
Reference Section
Veterinarian’s Name
*
First Name
Last Name
Veterinarian’s Phone
*
-
Area Code
Phone Number
Please provide two non-family references: Full Names and Phone Numbers:
*
Why do you want to adopt?
*
Is there any other information you wish to share?
*
By clicking the submit button, I understand that as part of the adoption process Petmatchmaker Rescue South will conduct a home and yard check if applicable.
By clicking the submit button, I understand that Petmatchmaker Rescue South will check my veterinary references.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Petmatchmaker Rescue South.
By clicking the submit button, I understand that this application does not guarantee me the animal I am applying for.
By clicking the submit button, I verify all of the above information is true and accurate.
Signature
*
Clear
Submit
Should be Empty: