Adoption Application

Dogs Name:

Name

First Name Last Name

Address

Street Address

Street Address Line 2

County

City, State, Zip:

Cell Phone #:

_ Work Phone #:

Email Address:

example@example.com

Employer’s Name:

Marital Status:

Spouse/Partner’s Name:

Ages of Applicants:

Do you live in: HOUSE APARTMENT CONDO DUPLEX MOBILE HOME TOWNHOME

Do you: OWN RENT How long have you been at this address?

Landlord’s Phone #:

How many adults reside in your household?

Are there children in your home? YES NO How many?

Ages?

Have you ever turned an animal in to a shelter before? If yes, please provide reason below:

If renting, we will contact your landlord to ask if having animals in the home is acceptable.

How many pets have you owned in the last five (5) years?

If you no longer have your pets from the last five (5) years, what is the reason?

Vets Name:

Vets Phone #:

Where will your new pet be when no one is home?

How many hours a day will your new pet be left alone?

Indoors?

Outdoors?

If renting, we will contact your landlord to ask if having animals in the home is acceptable.

If you are a member of a condominium or Homeowner’s Association:

Name of complex/association:

Restrictions such as weight, pet type, etc.:

Please list two (3) personal references:

Name

Address

Phone

How long known?

Please list all other pets in the home:

Dog/Cat/Other

Breed

Name

Age

M/F

Altered?

How long owned?

Blessed Paws Animal Rescue determines the criteria for adoption. Blessed Paws Animal Rescue may always refuse any specific request for any reason. Blessed Paws Animal Rescue will inform you of any medical treatments to be administered and any other restrictions or expectations we may have. You will be expected to keep the animal safe and secure.

Signature

Date

Blessed Paws Animal Rescue, Inc. by email:

blessedpawsanimalrescue@gmail.com

or phone: Vickie Virzi 561-306-9363

Where did you hear about this dog?

This is a fill in the Where did you hear about this dog? field. Please add appropriate blank fields and text.