Amarna's Place Application

Foster/Adoption Application
Which Rescue or Rescues are you interested in Adopting? (Name/'s) *
First & Second Choices
If unavailable what would your Adoption/Foster Preference be? (Check all that apply)*

FemaleMaleEither Male/FemaleYoungerOlderAny age
Check each option that you are interested in.*

Adoption OnlyBecoming a Foster to AdoptFoster Short termFoster Long termGet Pre-ApprovedBe put on a waiting listOther
Are you willing to work with us to correct any possible behavior issues that the rescue may have?*

YesNoTo a pointYes, Short term
Adopter Personal Information
Name*

First NameLast Name
Date of Birth? *
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Work Phone; *
Contact Number*
Yourself & Family
Please fill out the entire application. All questions marked with a ( * ) are required and they must be answered. If they are not, the application will not submit. If any of those marked required do not pertain to you, mark (N/A) in order to move forward with the application process.
List the Names & Ages of any additional (Adult) family members or those who live in your home. *
List the Names & Ages and Relationship to you of any Children under the age of #18 who live with you or who visit your home on a regular basis. *
List the Employers, Occupations & Hours of Everyone who lives in your home? *
Home Environment
Do you Own or Rent your home?*

OwnRentOther
Choose which best describes your living situation.*

HouseCondoApartmentModular Home
If a Rental, does your lease permit you to have animals?*

YESNOYES/ LIMITED
If living in an apartment / condo are there any restrictions on dog ownership or Breed? (Explain)*
Landlords Name;*

First NameLast Name
Landlord's Phone #*
Do you have a yard with a fenced in yard?*

YESNO
If Yes, Please describe in detail including the Type & Height of fence and any Security measures taken to prevent animals from escaping or being harmed by predictors.*
Please be specific with your description.
IF No, Please describe how you plan to exercise the rescue ?*
Rescue Animal Living Space & Care

This is important information, Please be Specific.
How many hours per day will your Rescue be left alone?*

1 -22 -44 -66 - 88 - moreNone
Please describe in Detail what the Rescues living situation will be. (Please give a detailed description including hours when no one will be home.)*
Please be very Specific with your answer .
Current & Previous Pets

Including Vet Care
Have you had rescues previously?*

YesNo
If Yes, name, ages, breed? Describe: Where you got them, where they are now and if re homed why? *
Please be specific
Other animals living in your home? (Click all that apply)*

DogsCatsCaged AnimalsNone
Are your pets currently UTD on Vaccinations?*

YesNoSome not All
Are your pets on Heart-worm Preventative?*

YesNoNot right nowThey will be
Are your pets Spayed or Neutered?*

YesNoNot YetSome not All
List ALL family Pets/ Include the Following: (Type / Breed / Age / Dates of last Vet. appointment & Vaccinations, Heart-worm, Flea meds. & Spay/Neuter dates) *
Have any of your pets Ever displayed any Food or other aggression's toward other animals or humans?*

YesNo
If so, Please give a detailed description. (Include: Date of any bite incidents) *
List all Previous pets that you've owned in the past 5 yrs. (Include: Years owned & where they are now. *
Vets & Personal References
Name & Address of Current Vet*

Name

Street Address Line

CityState

Zip Code
Phone Number*
Fax Number*
Name & Address of Previous Vet*

Name

Street Address Line

CityState

Zip Code
Phone Number*
Fax Number*
Phone Number*
Provide 3 personal References including at least 1 person who lives with you. (Include: How they know you).*
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By signing via electronicly I agree that the information that I have provided in this application is complete and correct. I understand that any false information I have provided will invalidate this and any future applications. I further declare that I am financially and physically able to care for a rescue animal. I understand that proper food and veterinarian care may be costly, and I am able and willing to meet the needs of my rescue animal. I understand the requirements and grant permission for Home Check prior to adoption. I submit that if a Home Check reveals falsification or misrepresentation of any facts on my part, Amarna's Place reserves the right to either refuse adoption or to nullify the adoption and reclaim said rescue from my premises without reimbursement of the adoption fees. I release Amarna's Place from any liabilities I may incur from the adoption process or by the rescue while in my care.
Please sign below: *

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Foster/Adoption Application

Adopter Personal Information

Yourself & Family

Home Environment

Rescue Animal Living Space & Care

Current & Previous Pets

Vets & Personal References

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