Save-A-Soul Rescue North Adoption Application

SAVE-A-SOUL RESCUE NORTH
ADOPTION APPLICATION
Please answer all questions. If not applicable to you, please answer N/A. Adoption fee is $300.00 for dogs 2yrs and under and $250.00 for adults over two
ABOUT YOU
Name of Primary Adopter
Name of Secondary Adopter
Address Street City State and Zip
Phone number
Alternate phone number
Email
example@example.com
ABOUT YOUR LIVING ARRANGEMENTS
Type of Residence

Apartment/CondoHomeOther (explain below)
Other, please explain
Do you

OwnRent
PLEASE NOTE that many rental contracts have breed restrictions associated with them therefore we have to verify this information before proceeding with the adoption process.

If you do rent, please provide your landlord's phone/email for verification if there are any
Phone
Email
example@example.com
How long at current residence?
Is there a fenced in yard?
Is there a busy street nearby?
PREFERENCES
Name (if specific interest)
Breed
Sex

MaleFemale
Desired age
What is the maximum age you would consider?
Desired Color
Do you prefer

MixedPure
Do you have any objections to a home visit by a representative of our rescue?

YesNo
Is this pet for you or a gift?

MyselfGift for another
Are there children in household? Please list names, ages and genders.
Do you currently own any other pets? Please list names, ages and genders.
Have you ever surrendered an animal to a shelter/rescue?

YesNo
Is there any reason that would make you give up your pet?
Please list dogs you have owned in past 10 years. List names and what happened to them.
Do you have a dog crate?

YesNo
Where would this pet live?
Have you ever obedience trained a dog?

YesNo
If yes, what facility or facilities have you used?
If desired breed is a Chow Chow, have you ever owned one before or familiar with the breed?

OwnedFamiliar only
If desired breed is a Chow Chow, how will you groom your Chow Chow and how often?
PLEASE NOTE if desired breed is a chow chow, we prefer not to place 2 chows of the same sex in a home together. Exceptions to this requirement will be considered on a case by case basis only.
REFERENCE - VETERINARIAN
Vet Name/Practice Name
Address
Phone number
Email
example@example.com
REFERENCES – PERSONAL

A person who has been in your home and preferably has seen how you cared for your past pets. List name, phone and relationship.
Name
Phone
Relationship
Name
Phone
Relationship
List one person who would always be able to reach you even if you move.
Name
Phone
Relationship
Is there anything else you would like us to know about your desire to own a rescue pet?
How did you hear about us?

FacebookWebsite/InternetFamily/FriendOther, please explain
If other, please explain
By typing your name below, you give SAVE-A-SOUL RESCUE NORTH consent to contact the designated veterinary office for proof of medical records and/or treatment, as well as contacting personal references.
Signed by
Date

MonthDayYear
Date
Should be Empty:

SAVE-A-SOUL RESCUE NORTH

ADOPTION APPLICATION

ABOUT YOU

ABOUT YOUR LIVING ARRANGEMENTS

PREFERENCES

REFERENCE - VETERINARIAN

REFERENCES – PERSONAL