PB Pet Adoption Application Form

Adoption Application and Waiver

Questions? Contact Patti at patti@therescueexpress.org
DOG ADOPTION APPLICATION

I understand that I am submitting an APPLICATION to be considered by THE RESCUE EXPRESS to adopt a rescue animal. I have read this entire document CAREFULLY and have fully disclosed any and all information requested. I understand this is not a CONTRACT to adopt, but an APPLICATION for consideration to adopt from THE RESCUE EXPRESS.
The Rescue Express is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. The Rescue Express is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.

This questionnaire is designed to help The Rescue Express and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. The Rescue Express reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.
Date

MonthDayYear
Date
Applicant Name*

First NameLast Name
Email Address*
Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
THE RESCUE EXPRESS requires an adoption fee to defray expenses for the dog’s transport, food, and preliminary veterinary care. The adoption fee is not a sale price for the dog and is ONLY refundable if the Adopter returns the animal within 14 days. The amount of the adoption fee is dependant on the dog and is communicated to the application by The Rescue Express.
The Rescue Express Adoptable Dog

If you have already identified a RESCUE EXPRESS dog you are interested in, please provide the following:
Adoptable Dog Name
Adoptable Dog Gender

MaleFemale
If you have not identified a specific dog yet, tell us about the type of dog you are interested in.
List breeds you would consider::
Gender of dog you would consider:

MaleFemaleEither gender
Age of dog you would consider:

PuppyAdultAny age
Would you consider a mixed breed dog?

YesNo
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)
Pets in Your Household

Tell us about the pets that are part of your household now.
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo
Do you own any pets?*
How many pets are part of your household
Enter a number
If you have pets now, tell us about each pet below:
Pet #1
Name of Pet #1
Pet #1 Breed(s)
Pet #1 Gender - Male or female. Are they altered?
Pet #1 - Type of Pert (Dog, Cat, Other)
Pet #1 - Temperament - good with all dogs? Only opposite sex dogs? All children? Young Children? Cats? Please provide details
Pet #2
Name of Pet #2
Pet #2 Breed(s)
Pet #2 Gender - Male or female. Are they altered?
Pet #2 - Type of Pert (Dog, Cat, Other)
Pet #2 - Temperament - good with all dogs? Only opposite sex dogs? All children? Young Children? Cats? Please provide details
Pet #3
Name of Pet#3
Pet #3 Breed(s)
Pet #3 Gender - Male or female. Are they altered?
Pet #3 - Type of Pert (Dog, Cat, Other)
Pet #3 - Temperament - good with all dogs? Only opposite sex dogs? All children? Young Children? Cats? Please provide details
Pet #4
Name of Pet #4
Pet #4 Breed(s)
Pet #4 Gender - Male or female. Are they altered?
Pet #4 - Type of Pert (Dog, Cat, Other)
Pet #4 - Temperament - good with all dogs? Only opposite sex dogs? All children? Young Children? Cats? Please provide details
Pet #5
Name of Pet #5
Pet #5 Breed(s)
Pet #5 Gender - Male or female. Are they altered?
Pet #5 - Type of Pert (Dog, Cat, Other)
Pet #5 - Temperament - good with all dogs? Only opposite sex dogs? All children? Young Children? Cats? Please provide details
Previous Pet Experiance

Tell us about pets you no longer have
Please provide information about the type of pet(s). If you no longer have the pet(s), please explain why.If deceased, please give age at which pet was deceased.
Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo
If you answered "Yes" to the above question, please provide detail:
Veterinary References

Please provide the name(s), address(es), and phone number(s) of any and all Vets you have used in thepast or are currently using. THE RESCUE EXPRESS will follow up and check references as it is ourpolicy to make sure that all potential adopters have taken good and appropriate care of their pets.
Please provide your veterinarian's name, address and phone number:
About your home environment

Tell us about your home and household
Do you own or rent your home?*

OwnRent
What is your landlord's pet policy?
If you rent, please provide your landlord's information here:
Do you have a yard?*

YesNo
If "Yes" to the above, is it fenced? please describe
Who Lives In Your Home?
Your Name*
Your Age*
Are there children in the home? (If yes, PLEASE LIST AGES)*
Adult #2 Name (if applicable)
Adult #2 Age (if applicable)
Please list any additional (other than those listed above) persons who reside in your home (PLEASE PROVIDE AGES):
PLEASE INCLUDE AGES OF ALL PEOPLE
Any family members with allergies to dogs?
Pet Care

Tell us about how you will be caring for the dog
How many hours per day would the pet be alone?*
Who will be responsible for the primary care of the dog?
Do you have a pet sitter or alternate person who will care for the dog if you are away for longer than 6 hours? If so, who?
If you have to leave town, emergency or planned, where would your pet stay?*
Where do you intend to keep the dog during the day?
Where do you intend to keep the dog during the night?
How much exercise will you provide the dog EACH day:
Training

Questions about training and behavioral issues
How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*
Please describe your training philosophy if adopting a PUPPY
Please describe your training philosophy if adopting an ADULT DOG
Consent

THE RESCUE EXPRESS reserves the right to review every applicant thoroughly and will consider thebest interest of the animal when making a decision regarding an adoptive home.
Name of Potential Pet Parent*
Signature (eSignature with mouse, or on screen of phone or tablet)

Clear
Should be Empty:

DOG ADOPTION APPLICATION

The Rescue Express Adoptable Dog

Pets in Your Household

Previous Pet Experiance

Veterinary References

About your home environment

Who Lives In Your Home?

Pet Care

Training

Consent