Application- Charlie's Angels Foster/Adoption

Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long at this address?:*
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
E-mail*
Name and Address of Employer:
Work Phone Number

Area CodePhone Number
Are you able to afford the adoption fee of $300/$350?*

YesNo
How were you referred to Charlie's Angels Rescue?*
Are you planning on moving within the next 6 months?*

YesNo
If yes, what are your plans for your pets if you move?
Are you 25 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Do you own your own home?*

YesNo
If no, name and phone # of landlord:
Type of Dwelling:*
Name and age of ALL occupants in household (including yourself):*
If no children, do you plan on having children or will children be visiting the household frequently?*

YesNo
How many total hours will your new pet be left alone during the day?*
Is your yard fenced in? If yes, is it partially or fully fenced? How tall is the fence?
Are any members of your household allergic to animals?*

YesNo
If yes, please describe:
Who will have chief responsibility for the care of your new pet?*
Where will your dog sleep?*
Where will your dog spend most of his/her time?*
Have you ever lost or surrendered a pet?*

YesNo
If yes, please explain:
List each individually including breed, sex & age:
Are your present pets up-to-date on their annual vaccines and rabies?*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered?*

YesNoN/A
If no, please explain.
Are you financially prepared to spend for routine/emergency medical care, licensing, etc?*
What plans do you have for your new pet when you are on vacation?*
Which dog(s) on our website are you interested in?*
Do you want to foster or adopt?*

FosterAdoptFoster, possibly Adopt
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER: *PLEASE MAKE SURE YOU CALL YOUR VET TO GIVE PERMISSION TO RELEASE INFORMATION AS MANY WILL NOT GIVE US A REFERENCE W/OUT YOUR CALL, AND WE WILL NOT BE ABLE TO PROCESS YOUR APPLICATION.*
Is your entire immediate family in agreement with the decision to bring a new pet into your home?*

YesNo
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 10 - 20 years (average life span)?*

YesNo
Are you willing to allow Charlie's Angels Rescue to make future visits to your home?*

YesNo
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?*

YesNo
If yes, please describe:
Have you ever adopted or tried to adopt a pet before? If yes, fill out info below.*

YesNo
Rescue Information

Name of RescueContact Name
Rescue's Phone Number

Area CodePhone Number
If other, please explain:
Please provide 3 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved. PLEASE BE AWARE: If your references are not easily reachable or do not reply in a timely manner, it will delay your application. If multiple references do not reply, your application will be filed on HOLD. Please choose your references carefully and be sure to list the correct contact numbers.
Reference #1*
First and Last Name & Relationship to Self
Reference # 1 Phone Number*

Area CodePhone Number
Reference #2*
First and Last Name & Relationship to Self
Reference #2 Phone Number*

Area CodePhone Number
Reference #3*
First and Last Name & Relationship to Self
Reference # 3 Phone Number*

Area CodePhone Number
If there is anything else you think we should know, please note it here.
Please remember, we are all volunteers and it may take approximately a week or more for us to get back to you.
Once we have received your application, you will receive an email confirmation within 24 hours.
Thank you so much for wanting to rescue a dog! If, for any reason, the dog is not a PAWFECT FIT, he/she MUST be returned to Charlie's Angels Rescue!
Should be Empty:

Please remember, we are all volunteers and it may take approximately a week or more for us to get back to you.

Once we have received your application, you will receive an email confirmation within 24 hours.

Thank you so much for wanting to rescue a dog! If, for any reason, the dog is not a PAWFECT FIT, he/she MUST be returned to Charlie's Angels Rescue!