Canine Adoption Application Form

We try very hard to match the right pet into the right family. Before committing to adopting a pet, please be prepared to keep this pet for life. It is hard on everyone, especially your pet, if s/he must go from home to home. Please be this pet's forever family! Thank you so much for your time and interest!

By completing this application you are giving written permission for Kentucky SAVE to contact: Your landlord and request a copy of your lease (if applicable), personal references, current employer, your veterinarian for confimation you are a current client and that any current pets are up to date on vacinations, heart-worm preventatives and flea/tick prevention; and all other statements/needs listed in the application or that arise during review and discussions with you.

Applicants are considered without regard to race, color, religion, creed, gender, national origin, sexual orientation, age, disability, marital or veteran status, or any other legally protected status.

Pet Applied for*

Name

Date*

How did you learn about us?

Name*

First NameLast Name

Date of Birth*

mmddyyyy

Drivers License*

License numberState and Expiration Date

Phone Number *

E-mail*

example@example.com

Best form of contact and best time to contact?

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Have you ever filled out an application with us before?*

YesNo

Are you currently employed?*

YesNo

Name of Emloyer

Length of Employment

Phone number of immediate supervisor

Please list at least 3 personal references*

Name, Phone Number, Best Time to Call, Occupation and Relationship to you

Do you Rent or Own your home?*

RentOwn

Renters ONLY

Landlord/ Company NamePhone Number

I / We live in a*

Do you have a fenced in yard?*

YesNo

How tall is your fence?

How Long have you lived in your current home? Do you plan to move in the next 6 months?*

The noise level in your home is...*

QuietLoud and BusyModerateOther

Would you allow a home visit?*

YesNo

Are there any kids in your home? *

How Many? Ages? Is this the child's first pet?

How many adults live in your home? *

How often do you have visitors in your home? *

Are you financially able to provide for a pet's needs? *food, toys, vet care etc.*

YesNo

Please describe your lifestyle*

Are you a homebody? Do you like to hike? Do you work from home? etc.

Does anyone in the household have pet allergies? If so, how do you plan to handle these allergies?*

Are all Members of the household in favor of getting a pet?*

YesNo

List all other current pets in your home*

Age, Breed, Altered or unaltered, kept inside or outside, up to date on shots, etc.

Is your pet used to other pets?

YesNoOther

Has your current pet ever had issues with sharing? (food, toys, beds, attention)

YesNoOther

If your pet is not used to other pets or does have issues with sharing, how do you plan to approach this with a new addition?

Vet Information*

List your current vet and phone number - what name your records under

List any family pets that may enter your home even though they may not live with you*

I plan for this pet to live mostly*

IndoorsOutdoors

Please explain*

What type of personality are you looking for in a pet?*

How many hours a day will your new pet be left alone*

What is your plan when your pet is to be left alone?*

How do you plan to exercise your pet and how often?*

Where will your pet sleep at night? Are pets allowed on the furniture in your home?*

How often are you out of town? What is your plan for your pet during those times?*

If you have had any pets in the past that are no longer with you, please list what happened to them*

Under what circumstances would you re-home a pet?*

What made you want to adopt this particular pet and why do you think you will be a good fit?*

I agree that this animal is being adopted for myself and will not be sold, adopted to, or given to another party

I agree to care for the animal in a humane manner. This includes supplying adequate food, water, shelter, attention, and medical care.

We recommend a visit to your eterinarian within seven (7) days of the adoption date. We believe these animals to be in good health (Unless otherwise disclosed with you), but do not guarantee the health of any animal or assume any financial responsibility for future veterinary costs.

I understand and agree that Kentucky SAVE makes no guarantees about the animal's temperament and is not responsible for future damages or injuries caused by the animal.

When adopting a pet, we expect you to make a lifetime commitment to the care of this pet. If, however, you ever find yourself unable to continue with this pet, you will contact Kentucky SAVE and return/surrender the pet directly to Kentucky SAVE. You will NOT place this adopted pet on Craigslist or other similar sites, you will NOT attempt to re-home this pet yourself without the consent of Kentucky SAVE.

I agree that I am at least 21 years of age and have a valid ID

I understand, without liability, Kentucky SAVE, may: Investigate my home and conditions under which the animal(s) is being kept; take possession of the animal(s) if, in the opinion of Kentucky SAVE, the animal(s) is receiving inadequate care, is being imporperly housed or handled, or if any conidion of this contract has been violated.

By typing my full name below, I certify this is my legal name and that I agree to all statements noted above and that information presented is true and accurate. I understand taht this pet will have an adoption fee and in the case I do recieve this pet from Kentucky SAVE, I will return it if I am ever unable to, or choose not to, care for the pet any longer. By signing this application, I am giving written permission to Kentucky SAVE to contact: my landlord and request a copy of my lease (if applicable), my veterinarian for confirmation I am a current client and that any current pets are up to date on vaccinations, heartworm preventatives and flea/tick prevention; and all other statements/needs listed in the application or that arise during review and discussions with me.

Electronic Singature*

Adoption Application Form

Applicant Details

Employment

Personal References

Tell us about your home

Your Home Life

Tell us about your current pets

Other Information

Agreement