A Home for Weary Wanderers

A Home For Weary Wanderers Adoption Application

Applicant Name

CoApplicant Name

Full Street Address City State Zip

Home Phone

Cell Phone

Email

example@example.com

When is the best time to reach you

Are you a US Citizen

Do we have permission to do a reference check on you And anyone in the household

Do you have a criminal background Please Note A criminal background will not necessarily prevent you from adopting but its important we know as much as possible

Have you ever been charged or convicted of any crime If so please explain

Are you employed unemployed or a student

Occupation

How did you hear about A Home for Weary Wanderers

General Questions How did you hear about A Home for Weary Wanderers

What dog are you interested in

Why are you choosing to adopt

Why do you think you would make a good parent to a rescue pet

Preferred energy level Low Medium High

Preferred Size

Would you consider a special needs animal

Would you consider taking a bonded pair

Pet ownership could be a 1520 year commitment Are you ready for that commitment

Who will have the responsibility of walks exercise training feeding etc

Where will the animal be kept during the day

Where will the animal be kept while youre not at home

If crating how long will the animal be crated

If longer than 6 hours do you plan on having a dog walker family or friend come in

Does the animal have the run of the house or blocked off from certain areas

Will the dog be kept outside

Will the dog be tied up or put on a runner outside

Will the dog have freedom of the entire back yard

If you have to move what will you do with your pets

For what reasons would you justify surrendering your pet

Are there any habits you wont tolerate

As we all know pet care can cost a decent amount of money every year such as food vetting emergency vets etc Are you willing to spend that kind of money on your pet

Have you ever surrendered sold or given away an animal

Please list full names and date of birth of all members including non family members that reside

Please list full names and date of birth of all members including non family members that reside with you

Current DogsCats Name age breed gender altered and if they are comfortable with other animals WE DO NOT ADOPT if your dog is not current on vaccines or not altered

What types of issues if any have you worked on with dogs youve had

If you don't have children living in the home, will your dog come into regular contact with

If you dont have children living in the home will your dog come into regular contact with children under 12

If yes how often and what are their ages

Does anyone in your household have allergies or asthma

Do you own or rent your home

How long have you lived at your current residence

Has your landlord given you permission to have an animal

Landlord's name and telephone number?

If you own your own home do you plan on getting the necessary town dog license

Have you verified with your homeowner's insurance policy that you have no breed/size

Have you verified with your homeowners insurance policy that you have no breedsize restrictions

Do you have a fully fenced in yard

If so please describe the type and height

Do you have a swimming pool

Ifso, is it blocked off? If not what kind of safety precautions would be used to prevent the dog

from having access

Name of Veterinarian Please contact your vet to preauthorize them to speak to our application processors Vet references are required for application to be considered

Address and phone number of vet

If you haven't used this vet for animal's entire life please list all names, addresses and phone numbers

If you havent used this vet for animals entire life please list all names addresses and phone numbers

Please provide 3 references, two of which should be non-family Reference #1

Name

Address city state and zip code

Phone Number

Best time to call

Relationship to you

How long have you known them

Name

Address city state and zip code

Phone number

Best time to call

Relationship to you

Name

Address city state and zip code

Phone number

Best time to call

Relationship to you

Agreement I/We attest that I/we understand that A Home For Weary Wanderers makes no guarantees or statements regarding any animal's age, breed, health, or temperament. While A Home For Weary Wanderers has made every effort to provide accurate history and assessment of all of the animals, A Home for Weary Wanderers is not able to guarantee any animal's age, breed, medical status or history, behavior or disposition. I/We hereby release A Home for Weary Wanderers and its directors, members, and representatives of any and all possible claims arising from injury or damage caused by an animal met or adopted by me/us to any person or property or relating to the health or temperament of the animal, including any expenses related there to. I/We have read all the terms and conditions of adoption as stated in the adoption contract. I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/We attest that a submission of this application does not guarantee adoption of a rescue animal. I/We agree to provide A Home for Weary Wanderers with a non-refundable $50 deposit once my application is approved, to hold the dog. I then agree to pay the remainder of the adoption fee before receiving the animal. A Home for Weary Wanderers has the right to reclaim at any time any animal they suspect is being treated improperly. If for any reason I can no longer care for the animal that I am adopting from A Home for Weary Wanderers, I agree to return the animal ONLY to A Home for Weary Wanderers.

Signature

Date

Signature

Date