Animal Adoption Application
TEAM MEMPHIS RESCUE & SUPPORT
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
Other
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
*
Submit (thanks!)
Should be Empty: