Animal Adoption Application

Animal you are interested in

Alternate Choice

Pet Parent *

First & Last Name

Age of Applicant: *

Your Address *

Street Address

Street Address Line 2

City State

Zip Code

Your Email *

example@example.com

Social Media and/or Websites

Your Phone Number

Area Code Phone Number

Alternate Phone

Area Code Phone Number

Do you own or rent your home?

OWN RENT

If you rent do you have permission for an animal?

Yes No

Landlord's Name

First & Last Name

Landlord's Phone

Area Code Phone Number

Number of Adults in Household

Ages of Adults

Number of Children in Household

Ages of Children

All are members of household in agreement with adopting an animal? *

Yes No

Is anyone in your home allergic to the animal you're planning to adopt? *

Yes No

What is your occupation?

May we do a home visit? *

Yes No

Please elaborate

Is your yard fenced? *

Yes No

How do you plan to exercise your pet?

Do you have a pool/hot tub? *

Yes No

List Current Pets (Please include Name, Breed, Age, Spay/Neuter, UTD Vaccines, Heartworm prevention)

Have you ever given a pet away? If yes, please explain why.

Previous pets/Duration (Please include Name, Breed, Age, Spay/Neuter, UTD Vaccines, Heartworm prevention)

What would you do if you had to move and the place you decided upon has a breed restriction or pet policy that prevents you from taking your pet to your new home?

Have you applied to adopt from another rescue? *

Yes No

Have you previously applied with us?

Yes No

Under what name?

Where will your pet be kept during the day?

Where will your pet be kept during the night?

How many hours will your pet be alone on a regular basis?

Cats only - Where will the cat be kept?

Indoor/enclosed catio only Outdoor/Indoors at night Indoor/Outdoors free access Indoors

Veterinarian's Name

Veterinarian's Phone

Area Code Phone Number

Please provide (2) NON-FAMILY references and their phone numbers. If no veterinary reference, please provide (3) NON-FAMILY references: *

Why do you want to adopt?

Do you have any additional comments, questions or concerns?

By clicking the submit button, I understand that as part of the adoption process Team Memphis Rescue & Support may conduct a home and yard check if applicable. By clicking the submit button, I understand that Team Memphis Rescue & Support may check my veterinary references. By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Team Memphis Rescue & Support. By clicking the submit button, I verify all of the above information is true and accurate.

Adopter's Signature *

Signature date *