Pre Adoption Application
Name of pet you’re interested in adopting?
Contact Information
Name of Adopter/person that will be in charge of this dog
*
First Name
Last Name
Date of Birth (Applicants must be 21 years of age or older)
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Driver's License Number and State Issued
*
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
EMPLOYMENT INFORMATION
Employer Job Title
*
Work Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
HOUSEHOLD INFORMATION
How many people live in the house other than yourself?
*
Please list the names and ages of people living in your home other than yourself.
*
Does anyone in your home have allergies to dogs?
*
Please Select
Yes
No
Does everyone in your home agree with the adoption?
*
Please Select
Yes
No
Do you live in a/an
*
Please Select
House
Apartment
Condo
Duplex
Townhome
Trailer Home
Is your yard
*
Please Select
Completely fenced
Partially fenced
Not fenced
No yard
Do you own or rent?
*
Please Select
Own
Rent
If renting/leasing are their pet restrictions?
Yes
No
If you rent, please provide landlord, Name and Phone number. We will contact your landlord to ask if animals are acceptable. You will not be able to adopt until we receive positive confirmation.
*
How long have you lived at this address?
*
Do you plan on moving anytime soon?
*
OTHER PETS AND VET INFORMATION
Do you currently have any pets?
*
Please Select
Yes
No
Number of dogs, cats, and other animals (birds, reptiles, ferrets, rabbits, etc.)
Are your pets spayed or neutered? If not, please explain why.
*
Are your current pets up to date on vaccinations?
*
Yes
No
Are your current pets on heartworm prevention?
*
Yes
No
Are your current pets on flea and tick prevention?
*
Yes
No
Do your current pets live indoors or outdoors?
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Indoors
Outdoors
Veterinarian Name
*
Veterinarian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Veterinarian Clinic Name
*
Will you be using the same veterinarian for your adopted dog?
*
Yes
No
If not, please write the name and phone number of the veterinarian you will use for your adopted dog.
*
Have you ever surrendered a pet of yours to an animal shelter or euthanized a pet? If yes, please explain
*
POTENTIAL PET ADOPTION INFORMATION
Will this dog ever be tied outside or in a kennel outside?
*
Yes
No
Where will the pet be kept during the day?
*
Where will the pet sleep at night?
*
If necessary, will you go through training with your pet?
*
Yes
No
Who will care for this pet when you are on vacation?
*
What would you consider a good valid reason for putting a pet to sleep?
*
What do you consider a good valid reason to for giving up a dog?
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Are you willing to take responsibility for this pet for 10 or more years?
*
Yes
No
How much do you think the total cost will be to care for this pet each year?
*
Will you take your dog to the vet for yearly vaccinations?
*
Yes
No
Over-the-counter flea and tick preventatives (Hartz, Adams, etc.) can be extremely dangerous to cats and dogs.
Reactions can cause problems such as skin inflammation, seizures, and death.
Do you agree to only use veterinarian approved products such as Revolution, Frontline, Advantage, Capstar, and Program?
*
Yes
No
Are you able to spend $500-$1,000 on emergency vet care?
*
Yes
No
Will the adopted pet have a collar and an ID tag?
*
Yes
No
Do you understand that a pet adopted from an animal rescue may take more time to form a bond, may display fearful behavior initially, and may take time to gain trust and adjust to its new surroundings and family? Do you also understand that rescued dogs may also need more time and attention initially to help overcome trauma it may have endured in its past?
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Are you willing to work with any behavioral issues the dog may develop over time? Please explain what actions you will take if this dog ever bites you:
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Do you understand the importance of slow and proper introduction of your new dog to other pets and family members/friends?
*
Do you understand that your adopted dog may have accidents inside the house and it is up to you to teach them not to through positive reinforcement?
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Will you commit to this pet for its lifetime despite changes in your life?
*
Riley’s Pet Rescue to perform a home visit on an approved adoption application to ensure that the home environment is the best fit for the dog?
*
Do you understand that if you can no longer care for your pet/this adopted dog you will return him only to Riley’s Pet Rescue Inc.
*
Do you certify that all of the above information is true and complete and is subject to verification by Riley’s Pet Rescue?
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Applicant's signture
*
Co- Applicant Signature
Do understand an adoption fee will take place and is a non refundable fee.
*
Submit
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