Name of the Pet and ID number if known
*
Applicant Details
Name
*
First Name
Last Name
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Mobile)
*
Phone Number (Work)
*
Phone Number (Home)
*
E-mail
*
example@example.com
Occupation
*
Do you own or rent your home? If rent are you prepared to show landlord permission for the new pet?
*
I / We live in a
*
Single Family Home
Duplex / Twin
Condo / Townhome
Trailer
Apartment
Other
Why are you interested in adopting a pet at this time/
*
Have you ever adopted a rescue before?
*
What type of dog/cat are you looking for? Click all that apply
*
male
female
Puppy
Adult
Senior
Family companion
active (hikes, runs, ect)
Homebody/couch potate
Social butterfly with people
Social butterfly with dohs
travel buddy
Do you have another pet?
*
Yes
No
Please list how many dogs/cats you have had in the past 10 years, breed, how long they lived with you and what happened to them.
*
Please list all occupants of your home including yourself, their ages and their relationship to you.
*
Number of hours each day pet will spend alone
*
Is anyone in your household allergic to any animals?
*
Do you have any other pets in the home? If yes, what kind, gender, breed, age spayed/neutered?
*
Do you have a fenced in yard?
*
Yes
No
How high is your fence?
*
Is your pet used to other pets?
Yes
No
Other
Where will the animal be when you are home?
*
Where does the pet stay (be confined) while you are out?
*
Do you understand there is an adjustment period that's roughly around 3 months for a newly adopted dog?
*
Have you ever had to rehome an animal before? If so please explain
*
Are there any traits/behaviors would not be willing to work on with your Pet? Please note, with proper training plans in place these behaviors most likely can be prevented or worked on
*
Potty accidents in the home
Destructive behavior (chewing on furniture, clothes, ect)
Leash reactivity to dogs or people
Off leash dog aggression
There are no reasons-I will do whatever is needed
off leash people aggression
excessive barking/howling
separation anxitey
What do you plan to feed your pet?
*
Are you prepared to potty train your new pet?
*
How do you discipline your pets and why? (describe)
*
Do you have a regular veterinarian?
*
Yes
No
Veterinarian’s name
*
Clinic Name
*
Clinic's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clinic's Telephone
*
Number of hours (average) pet(s) spends alone
*
Please add at least two references
*
Are you prepared to physically, emotionally and financially take care of your pet for the rest of its life?
*
Have you applied with other rescues? If yes, which rescues?
*
How did you hear about us?
*
I confirm that all information supplied above is correct and accurate.
Signature
*
Submit
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