Pet Adoption Application Form

Pet Adoption Application

Prospective Pet Parent*

First NameLast Name

Name or ID of Pet You Wish to Adopt*

If you are submitting an application but not sure for which pet, write N/A

Email Address*

Phone Number*

Social Media Handle(s)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

List other pets in the home (type, age, temperament), if any. If none, write N/A.

Please provide your veterinarian's name and phone number, if applicable:

Do you own or rent your home?*

OwnRentOther

Do you have a fenced yard? If yes, how tall is your fence?*

If you rent, please provide your landlord's information. If you own, write N/A.:*

What is your landlord's pet policy? If not applicable, write N/A. *

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:

Are there children in the home? (If yes, please list ages)*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you leave town for an emergency or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, or unruly leash behaviors in your pet?*

Please provide the names and contact information for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal neglect, or animal abandonment?*

YesNo

Have you ever been convicted of domestic violence or sexual assault?*

YesNo

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

Do you agree to a background check, home check, and to provide references upon request?**

Yes

By clicking the submit button, I agree to abide by Animal Safehouse policies and requirements through the adoption process, including possible background check and/or home visit.
By clicking the submit button, I understand Animal Safehouse will check my references including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet from Animal Safehouse and that it is tax deductible according to IRS 501(c)3 guidelines.
By clicking the submit button, I understand that if I can no longer care for my adopted pet, I agree to notify Animal Safehouse BY EMAIL to animalsafehouse@gmail.com and provide a 14-day period to allow for necessary arrangements for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless Animal Safehouse against any losses, lawsuits, claims, injury, or damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Animal Safehouse will disclose all pets' known health and behavior issues.
By clicking the submit button, I verify all of the above information is true and accurate.

Signature of Potential Pet Parent*