Small Animal Adoption Application

We are completely run by volunteers and receive dozens of applications a week. Those short listed will be notified. Thank you in advance for applying.

OUR ADOPTION PROCESS:

We are located in Victoria British Columbia. We are staffed entirely by volunteers and have no shelter or other facility. Our wonderful foster families care for all adoptable pets. If you are interested in adopting a pet, please read about our Adoption Process & Fees below for more information.

https://brokenpromisesrescue.wordpress.com/adoptions/adoption-process/

Helping Local and BC Animals

This questionnaire is designed to help Broken Promises Rescue find the best possible home for our adoptable animals. All adopting parties are required to complete this form prior to adoption.

Name of the animal(s) you are interested in: *

Are you looking to adopt a pair or a single? *

Name

First Name Last Name

Spouse

First Name Last Name

Your age:(must be 21 years of age) *

Spouse's age:

Address *

Street Address

Street Address Line 2

City Province

Postal

Phone: *

Area Code Phone Number

Cell Phone:

Area Code Phone Number

E-mail:

Employer:

Are all members of your household in agreement with this adoption? *

Yes No Don't Know (it's a surprise)

Who will be the pet's primary caregiver? *

Do you live in a *

House Apartment Condo Mobile Home

Do you own or rent? *

Own Rent

Are there pet any restrictions from your landlord?

Yes No

Landlords Phone: (to confirm Pet Policy)

Area Code Phone Number

How long have you lived at this current address ?

Do you plan to move and if so when ?

How many children are in your household?

If children, what are their ages?

Have your children been around animals before?

Yes No

Does anyone in your home have allergies to animals or have asthma? Any Allergies to hay or straw? *

Yes No

Do you agree to a Home Visit Prior to Adoption? (Please read our Process during Covid on our Website) *

Yes No

Are you chosing this pet for yourself ?

Yes No

Do you currently have animals in your home?

Yes No

Please tell us about other pets you currently have in the home (type, and age)

List any pets you own or have owned in the past, and their ages (do not include childhood pets)

How many of these pets are spayed/neutered?

Where are these animals now?

Have you adopted before?

Yes No

If yes, what group?

Please provide the name and phone number of your current and/or previous veterinarian or clinic OR the name of the Clinic you plan to go to:

How many hours each day will your new pet receive human companionship? *

Where will your new pet spend it's time? (once settled): *

Inside Only Indoor/Outdoor Outdoor Only Indoor Only with outside access (please explain below)

Where would your pet be kept when you are out or at night *

Please describe the caging/housing you will provide for this animal *

Are you willing to work through your new pet's issues, if any? *

Yes No

Will you allow this animal to go outside of it's cage? Why or Why not? And how often? *

Yes No

How much are you prepared to spend in one year for your pet (food, supplies, toys, vet visits etc.)

$5-$100 $100-$300 $300- $500 $500-$1000 What ever is needed we are prepared financially

How often Will you take your pet to the vet ?

If Signs of Illness or Injury When Vaccines are Due Yearly for a exam

Why do you want this pet? *

Companion for you A Gift Companion for other pet Teach kids responsibility

Who would you contact if you needed advice regarding your pet(s)? *

Where do you plan to purchase your pet food ?

Pet Store Grocery or Box Store Vet office Make your own

What kind of food are you planning on feeding your pet ? Please be specific *

How long do you expect to have your pet ? *

Have you ever surrendered or had to give up a pet before ? please explain *

What will you do with this pet if you have to move ?

Take with me Find a New home Give to the SPCA Give to a friend/Family Return it to BPR

Please tell us why you think you would be a good home for this pet ? *

Do you agree to pay an adoption fee and have you read about our Adoption Process and Fee's ?https://brokenpromisesrescue.wordpress.com/adoptions/adoption-process/

Yes No

Please email us a photo and dimentions of the cage/housing you plan to use for this new pet.

info@brokenpromisesrescue.com

How did you find out about Broken Promises Rescue? *

Facebook Friend/Family Member Website

Agreement & Signature

Broken Promises Rescue attempts to give an honest evaluation of any animal based on our assessment or that of the source. Should you encounter any behavourial concerns, please contact us so we are able to work together to resolve the issues.

All applications are evaluated without bias. We evaluate based on the needs of the animal. Applications are not guarantee of acceptance. Any falsehoods will be automatic disqualification.

Thank you for wanting to opening your hearts and home to one (or two!) of our amazing animals! We appreciate your application and ask for your patience as we work through the applications. We are 100% volunteer run so we try to get back to you as soon as we can.

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

By submitting this application, I affirm that what I have submitted is truthful and complete. I also understand and agree to the policy as outlined in this document.

Broken Promises Rescue

Applicant Information

Household Information

Current/Previous Pet Information

Pet Information