Southern Paws Rescue Adoption Application

Name*

First NameLast Name

Name of the animal you wish to adopt*

Phone Number*

Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Where are you planning to keep said animal?*

OwnRent

Do you: [Own / Rent] If renting, do you have permission from your landlord to have a pet? [Yes / No]

Landlords Name and Contact Information

YesNo

Are there children in the household: [Yes / No] If Yes, if needed will you supervise them: [Yes / No] Does anyone in the household have allergies to pets? [Yes / No]

Do you currently have any pets? [Yes / No]

YesNo

YesNoN/AOther

If yes please list all current pets

and how many?

Total Number of Pets

Veterinarians Name*

If you do not have a Vet please put N/A

By signing below, I confirm that the information in this application is accurate. Providing false information may lead to denial of my application. If I can no longer care for the pet, I will return it to Southern Paws Rescue. We recommend that you take your pet to a veterinarian within the first week of adoption for a health check-up. I understand the responsibilities and costs associated with pet ownership and agree to provide a loving and permanent home for this animal. I will follow the care instructions provided and contact the shelter/rescue if I have any questions or concerns. All costs after said adopted date are the responsibility of the adopter, not the rescue. All adoption fees are non-refundable.

Signature*

Date*

Date

YesNo