Rescue Dog Adoption Application

Almost Home Animal Rescue & Adoption

SMALL ANIMAL ADOPTION APPICATION
This questionnaire is designed to help Almost Home Animal Recue and yourself determine if a specific pet is the right one for you and your household. All adopting parties are required to complete this form prior to adoption.
Applicant Information
Today's Date*
Your full name:*
Street Address:*
City, State, Zip*
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Name of small animal you are interested in?
Type of small animal you are interested in?
Character reference and phone number:
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you have experience with the animal you wish to adopt?*
Do you currently have any animals now? (Type, Breed & Age)*
If this is not your first small animal, how long did your previous one live & what happened to them?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow Pets?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?
Have your children been around animals before?

YesNo
Does anyone in your home have allergies to pets?*

YesNo
Current/Previous Pet Information
List any animals under you care (Type & Breed)
Where are these animals now?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Who is this pet for?*
What Kind of housing are you planning for your small animal in terms of location?*
Describe the space or areas for your small animal will have for out-time*
How often will the small animal get out-time?*
Do you plan to keep or take your small animal outside?*
What will your small animals diet consist of?*
If you have young children, cats, dogs or other predatory animals, how will you keep your small animal safe?*
How many hours will your pet be alone daily?*
If you had to give up your dog, what would you do with him/her?*
ALMOST HOME ANIMAL RESCUE RESERVES THE RIGHT TO REFUSE ANY ADOPTION.

I agree that if we adopt a small animal it will get hte necessary vet care required, a nutritious diet, and a loving home.

I agree I will return the small animal I adopt to ALMOST ANIMAL RESCUE & ADOPTION if we can no longer keep it.

I agree that no member of my household has EVER been convicted of animal cruelty.

Please Sign Below:

X_________________________ Date: _______________
Should be Empty:

Almost Home Animal Rescue & Adoption

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information