Adoption Application
Submit this application to apply to adopt a Charlie's Rescue animal. If you have any questions, email charliesrescuems@gmail.com
Applicant Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Social media (Facebook, instagram, etc.)
*
Age
*
Employer/Occupation
*
List all individuals living in your home full-time or part-time?
*
Rows
Name
Age
Full-time or Part-time?
Relation to Applicant
Person 1
Person 2
Person 3
Person 4
Person 5
If more space is needed, please list below.
Is anyone in your home allergic to pets?
*
Yes
No
Is everyone in your in agreement about adopting a pet?
*
Yes
No
Co-Applicant
Co-Applicant Name
First Name
Last Name
Relation to Applicant
Phone Number
Please enter a valid phone number.
Email
example@example.com
Social media (Facebook, instagram, etc.)
Age
Employer/Occupation
Back
Next
Type of pet wanted
*
Please Select
Puppy
Kitten
Adult dog
Adult cat
Explain which physical preferences are important to you. (e.g., breed, color, fur type/length, size, etc.)
*
Explain which temperament, personality, and activity level are important to you.
*
Sex wanted
*
Please Select
Female
Male
Is there a specific animal you are interested in?
*
Why do you want to adopt a pet?
*
Please Select
Family companion
Companion for pet
Protection/guard dog
Gift
Other
How soon will you be ready to adopt?
*
-
Month
-
Day
Year
Date
How did you hear about Charlie's Rescue?
*
Current/Former Pets
Do you currently have pets?
*
Please Select
Yes
No
Please list your current pets.
Rows
Name
Animal Type
Sex
Breed
Spayed/Neutered?
Age
Length of ownership
Pet 1
Dog
Cat
Other
Female
Male
Yes
No
Pet 2
Dog
Cat
Other
Female
Male
Yes
No
Pet 3
Dog
Cat
Other
Female
Male
Yes
No
Pet 4
Dog
Cat
Other
Female
Male
Yes
No
Pet 5
Dog
Cat
Other
Female
Male
Yes
No
If more space is needed, please list below.
Do you have any concerns about your current pet(s) accepting a new pet in the home? If yes, please explain.
Have your pets been around other pets? Describe the environment(s), parameter(s), etc. in which your pets currently interact with other pets.
Please list all pets you have had in the past 10 years, but who no longer live in your home.
Rows
Name
Animal Type
Length of ownership
Reason you no longer have the pet
Pet 1
Dog
Cat
Other
Pet 2
Dog
Cat
Other
Pet 3
Dog
Cat
Other
Pet 4
Dog
Cat
Other
Pet 5
Dog
Cat
Other
Have you adopted a pet from a rescue organization previously?
*
Please Select
Yes
No
If yes, which organization and when?
Do you still have the pet?
Please Select
Yes
No
List the Veterinary or Animal Clinic you currently use or have used in the past.
*
Phone Number
*
Please enter a valid phone number.
How long have you used this vet?
*
Have you been to this vet in the last 12 months?
Please Select
Yes
No
Are your pets current on their vaccines?
Please Select
Yes
No
Are your pets current on heartworm prevention?
Please Select
Yes
No
Are there any special considerations or treatments your pets are receiving from your vet currently? Please explain below.
Back
Next
Type of residence
*
Please Select
House
Apartment
Condo
Townhome
Mobile home
Do you currently rent your home
*
Please Select
Yes
No
If renting, does your landlord allow pets?
Please Select
Yes
No
If yet, please provide your landlord's name and phone number.
My yard is:
*
Please Select
Fully fenced
Partially fenced
Not fenced
Dog run/kennel
No yard
If you have a fence, how tall is it and what material is it?
Do you have a doggie door?
Please Select
Yes
No
Do you have a pool?
Please Select
Yes
No
I plan to keep my pet:
*
Please Select
Mostly indoors
Mostly outdoors
Both
On average, how many hours will your pet be home alone each day?
*
Please Select
0-2
2-4
4-6
6-8
8-10
10+
Where will your pet stay when you are are home?
*
Where will your pet stay when you are NOT home?
*
How often do you travel?
*
Where will your pet stay when you are out of town?
*
What will you do if your dog misbehaves or becomes destructive?
*
Are you willing to work with a new pet on house breaking?
*
Please Select
Yes
No
Under what circumstances would you NOT keep your adopted pet? (e.g., moving, travel, destructive behavior, have a baby, cost of care, divorce/marriage, shedding, medical/health issue, etc.). Explain below.
*
Back
Next
If you become unable to take care of this pet, do you agree to return them to Charlie's Rescue?
*
Please Select
Yes
No
Will you ensure your pet remains up to date on vaccinations, heartworm prevention, and receives any necessary medical care?
*
Please Select
Yes
No
Will you keep an identification (ID) tag with current contract information on your pet at all times?
*
Please Select
Yes
No
Will you allow us to do a home visit before adoption and also after adoption to follow-up?
*
Please Select
Yes
No
Would it be OK for us to contact you following adoption for an update on your pet?
*
Please Select
Yes
No
Applicant Signature
*
Date
-
Month
-
Day
Year
Date
Co-Applicant Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
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