Adoption Application

Pinelands Unleashed Rescue Co.

Adoption Application
Name of Animal You're Interested In:
Dog or Cat:
Date:

MonthDayYear
Date
In order to be considered as an adopter you must:
- Be 18 years of age or older
- Have identification showing your present address
- Have the knowledge and consent of your landlord
- Be able and willing to provide a loving, safe and peaceful environment for this pet
- Be financially stable and willing to provide any necessary medical care
Pet ownership is a big commitment. Pinelands Unleashed Rescue Co.'s application process is built to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.
The following questionnaire has been designed to aid both you and the adoption group in deciding if you and/or your family are adequately prepared to assume the responsibilty of pet ownership. Please be sure to ANSWER ALL QUESTIONS and feel free to add your own comments. If a question does not apply write N/A.
Name:
Age:
Phone Number

Area CodePhone Number
Email:
example@example.com
What is the best way to contact you?
Address

Address

Street Address Line 2

CityState / Province

Zip
Occupation:
Spouse's Occupation:
Please list the name, age and relationship to yourself of each person currently living in your house (ex Mary, spouse, 35)
YesNo
HouseCondoApartmentTownhouse
OwnRent
Less than 800 square feet800-1,000 square feet1,000-1,500 square feet1,500-2,000 square feetOver 2,000 square feet
Length of time at current residence
NoYes
YesNo
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Is there a pet deposit? How much?
What is the name of the property owner/ agent?
Contact name and phone number:
YesNo
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If yes, please describe local dog regulations and restrictions:
Companion for you / family / another petGuard DogGift (for whom)Add a family member to the familyOther
Not ApplicableYesNo
YesNoNot ApplicableOther
Indoor onlyMostly IndoorMostly OutdoorOutdoor only
Where will your new pet sleep at night?
In what areas of the house will the dog/cat be allowed?
0‐22‐44‐66‐88‐1010‐12over 12
Yes, woodYes, chain LinkNoYes, vinylOther
Height of fence
BalconyPoolPet DoorUnscreened Windows
YesNoOther
YesNo
Where do your pets stay if and when you travel?
Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWill be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
PAST/PRESENT PET HISTORY
Please list the name, type, age, gender, and if pet is spayed or neutered of ALL current animals. (example: Duke, Yellow lab, 1 year old, male, neutered)
Please list age, type, gender and if the pet was spayed or neutered for all animals you no longer have and what happened to that animal. (Ex Rosie, German Shepard, spayed female, passed away due to old age)
NoYesOther
Date of last vaccinations:

MonthDayYear
Date
If adopting a CAT, do you plan to declaw?
How often do you think a dog/cat should go to the vet for routine care?
Name of current or last veterinarian? Name/phone number?
YesNoOther
Moving to another stateFleas or sheds too muchHaving a babyFinished school/ moving back homeRuins the furnitureChildren will no longer care for dogToo expensiveAllergiesGetting a divorce or marriedFound a new “no pet” rentalGrew too bigDigging/ ChewingWould not give up for any reasonOther
What would you do with your pet if you could not keep it for any of the reasons stated above?
YesNo
If yes, why?
What would you do if your dog/cat was having a hard time adjusting to their new home?
In what instance would you no longer be able to keep your dog/cat?
Do you agree to seek and pay for a training consultation with one of our approved trainers before returning a dog/cat to us?
Do you plan on getting pet insurance? How do you plan on handling a potential medical emergency?
How long would you give your dog/cat to settle into your home?
What would happen to your pets if something were to happen to you? (Loss of housing, illness, etc)
Would you allow an inspection of your home and/or yard?

PLEASE PROVIDE TWO PERSONAL REFERENCES:
Name

First NameLast Name
EMAIL:
example@example.com
Phone Number

Area CodePhone Number
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Is there anything else you would like to tell us that you think would be important when considering your application?
How did you hear about Pinelands Unleashed Rescue Co?

Please read and sign below: Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit their individual needs. Please ask for clarification if you have any questions.
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!
Please allow 10 to 14 days for your application to be processed by our team. We are a small, volunteer based organization and will ensure each application is processed thoroughly. If you do not hear from us within 2 weeks, please email pinelandsunleashedrescueco@gmail.com
I have completed this application truthfully and fully understand the adoption process.
Date:

MonthDayYear
Date
Signature:

Powered by Jotform SignClear
Should be Empty:

Pinelands Unleashed Rescue Co.

In order to be considered as an adopter you must:

PAST/PRESENT PET HISTORY

PLEASE PROVIDE TWO PERSONAL REFERENCES:

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!