Pet Adoption Application Form

Mt. Pleasant Animal Rescue Adoption Application

Today's Date

Date

Your Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email Address

Phone Number

Area CodePhone Number

*Drivers license information must be provided if you are approved for adoption.

Employer Name

Employer Phone

Name of Pet You Wish to Adopt

Do you currently own any pets?

For each pet you currently own, please list their name, breed, if male or female, and age.

For each pet you currently own, please indicate if they are spayed/neutered and up-to-date on vaccines.

What is your pet's disposition and behavior towards other dogs and cats?

If you currently have dogs, are they on a heartworm preventative?

Other

Please provide your veterinarian's name and phone number:

How many pets have you owned in the past 10 years and what became of them?

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?

Do you own or rent your home?

If you rent, please provide your landlord's name and phone number:

If you rent, what is your landlord's pet policy?

Do you have a yard?

If you answered "yes" to the question above, is it fenced in and how how high is the fence?

Do you live in:

Other

Where will your pet live during the day?

Other

Where will your pet sleep at night?

Other

Have you considered the expense of this pet, both routine and unexpected illnesses?

Have you ever been convicted of a crime?

If you answered "Yes" please provide a detailed description:

How did you hear about Mt. Pleasant Animal Rescue?

Is there any other info that may be helpful in evaluating your application?

By clicking the submit button, I agree to the Mt. Pleasant Animal Rescue adoption process, will undergo a homecheck, and interview at the discretion of Mt. Pleasant Animal Rescue. By clicking the submit button, I understand Mt. Pleasant Animal Rescue will check my veterinary references. By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Mt. Pleasant Animal Rescue. By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Adopter

Must be 21 years of age.