Trapped in a peculiar world Adoption Application Form
Name of the Pet
*
Type of pet
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
How many adults live in the home ?
How many children live in the home?
Do all members of your household agree to this adoption? (All members living at the home will need to be present at the initial meet)
I / We live in a
*
Single Family Home
Duplex / Twin
Condo / Townhome
Trailer
Apartment
Other
Do you own or rent ?
*
Rent
Own
Live with family member
If you rent please provide Landlord’s name, phone number, and a signed consent form from them.
How long have you lived at your current address?
Do you have a fenced in yard?
*
Yes
No
How high is your fence?
*
Do you have another pet?
*
Yes
No
Is your pet male or female?
*
Male
Female
Is your pet used to other pets?
*
Yes
No
Other
Is your other pet(s) spayed/neutered?
*
Yes
No
Where does the pet stay (be confined) while you are out?
*
How do you discipline your pets and why? (describe)
*
If something happens to you (medically, financially, you need to move, or any other unforeseen circumstance) what is your plan for the animal?
Is anyone in the home allergic to animals? If so, how will these symptoms be managed?
Who is the pet for? Who will be the primary caretaker?
Do you have a regular veterinarian?
*
Yes
No
Veterinarian’s name
*
Clinic Name
*
Clinic's or veterinary’s Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clinic's or veterinary’s Telephone
*
Number of hours (average) pet(s) spends alone
*
Please add at least two references
*
Do you agree that if the animal does not work out in your home, they MUST be returned to the rescue?
Do you agree that any animal being placed in a home prior to their spay/neuter is considered foster to adopt and you will not have ownership of the animal from the rescue until the animal is spayed/neutered?
If we would require a home check, would you be willing to allow one to be done?
Do you understand there is an adoption fee?
I confirm that all information supplied above is correct and accurate.
Signature
Submit
Submit
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