“Saving one dog will not change the world, but surely for that one dog, the world will change forever.” ― Karen Davison
Name of the Pet Desired to Adopt
*
Applicant Details
Name
*
First Name
Last Name
Spouse or partner name (joint applicant)
*
First Name
Last Name
Date of Birth of primary applicant
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you lived at your current address?
Phone Number (Mobile)
*
Phone Number (Work)
*
Phone Number (Home) (put cell if none)
*
E-mail
*
example@example.com
I / We live in a
*
Single Family Home
Duplex / Twin
Condo / Townhome
Trailer
Apartment
Other
Do you....
Own our home
Rent our home
Who is your employer?
Occupation
How many children do you have and what are their ages?
Please list anyone living in the home not mentioned above:
Do you have a fenced in yard?
*
Yes
No
How high is your fence and what kind is it?
*
Do you have a pool or spa?
Yes
No
If yes, is the pool or spa fenced in?
Yes
No
Do you have any other pets?
*
Yes
No
If yes above, please add the type/breed/age/and whether spayed or neutered.
Are your pets used to other pets?
Yes
No
Other
Where does the pet stay (be confined) while you are out of the home?
*
How do you discipline your pets and why? (describe)
*
Have you ever surrendered a pet?
Yes
No
If yes to above, why?
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
*
Who will be responsible for daily care of the pet (feeding, water, walks)?
Who will financially support the pet?
Where will you keep the pet when you travel?
Will you keep the pet up to date on heartworm prevention?
Yes
No
Will you keep the pet up to date on required vaccines?
Yes
No
Please add at least two references
*
I confirm that all information supplied above is correct and accurate.
PLEASE READ:
I certify the above is true and that false information may result in nullifying this adoption. The Rufus Relief Fund has the right to refuse adoption to anyone. I understand that no animal can be held for me. I know and agree that The Rufus Relief Fund can reclaim the animal if they feel it is not being kept in acceptable conditions. I also agree that if I ever need to surrender the dog, The Rufus Relief Fund has first right of refusal to reclaim the animal before other means are chosen. The Rufus Relief Fund operates on donations and money raised. All donations are at your discretion and are non-refundable.
Signature
Submit
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