Adoption Application

ADOPTION APPLICATION

Whitsend Animal Rescue 10 Cherry Lane Blairstown, NJ 07825
Applicant Information

Please provide your personal details below.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Primary Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How long have you lived at this address? (In years and months)
Home Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Employment Information

Tell us about your employment status.
Name and Address of Employer
Work Phone Number
Please enter a valid phone number.
Housing Information

Details about your home and living situation.
Do you own your home?

YesNo
If you rent, please provide your landlord's name and phone number.
Type of dwelling
Are you planning on moving in the near future?

YesNo
If yes, what are your plans for your pets if you move?
If you live in a condo, townhome, or HOA community, please upload written proof you are allowed to have this type of animal and any restrictions.

Cancelof
How many hours will your new pet be left alone during the average day?
Do you plan to use a crate for your new pet?

YesNo
If using a crate, how many hours per day will your new pet be in the crate?
If not using a crate, where will your new pet stay during the day?
Household Information

Tell us about everyone living in your household.
List the name and current age of all occupants in the household.
If no children, will small children be visiting frequently?

YesNo
Are you planning on having children?

YesNoNot Sure
Are any members of your household allergic to animals?

YesNo
If yes, please describe allergies.
Who will have chief responsibility for the care of your new pet?
Pet History

Your experience with pets.
Over the past 5 years, how many pets have you owned? (Include current pets.)
List each pet individually. (Breed, age, still living with you? If not, why?)
Have you ever lost, given away, or rehomed a pet?

YesNo
If yes, please explain:
Have you and your spouse/partner ever owned a pet together?

YesNoN/A
If yes, when?
If you currently have pets, how do they react to new animals? Any behavioral issues?
Are your present pets up-to-date on their annual vaccines?

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

YesNoN/A
If no, please explain:
Were your previous pets spayed or neutered?

YesNoN/A
If no, please explain:
Veterinarian Information

Please provide your veterinarian details.
Who is your current or most recent veterinarian? (Name, Address, Phone)
Adoption Preferences & Readiness

Let us know about your adoption plans and preferences.
Why are you choosing to adopt vs. buying from a pet store or breeder?
Are you able to afford the adoption fee? (Varies by species: $350 for dogs, $400 for puppies; others vary.)

YesNo
What is your timing for wanting to adopt?

ImmediatelyNear futureJust want to be approved for the right rescue animal in future
How were you referred to Whitsend Animal Rescue?
Which animal(s) on our website are you interested in?
If considering a puppy, are you prepared to deal with and have you thought about the following issues: housetraining, chewing, barking, crying at night, high energy level, nipping, socializing, and training?

YesNo
Are you currently applying to other rescues? (Applicants applying only to Whitsend will be screened first.)

YesNo
If yes, list the rescue(s) information below.
Please provide details related to your previous applications or adoptions.
Pet Care and Lifestyle

How will you care for your new pet?
How much are you financially prepared to spend for routine and/or emergency medical care, licensing, etc.?
What plans do you have for your new pet when you are on vacation?
How do you plan on exercising your pet and providing enrichment?
Where will your pet spend most of his/her time?
If other, please explain:
If your pet will spend time outside unsupervised, describe any shelter available.
Describe your fence:
If no fence, would you be willing to install some type of fence?

YesNo
Where will your pet eat?
Where will your pet sleep?
Will you provide your pet with monthly flea/tick prevention?

YesNo
Will you provide your pet with monthly heartworm prevention?

YesNo
Are you prepared to and financially able to provide your pet with annual veterinary exams, annual vaccinations, and any necessary veterinary care as needed?

YesNo
What brand of food do you plan on feeding your new pet?
How would you deal with any behavioral issues that may come up? (What is your style/method of training?)
What type of behavioral issues are you NOT willing to work with? (Check all that apply.)

HousetrainingNippingFood AggressionShy/Scared PetsDestructive BehaviorChewingDiggingChasing Cars/BikesExcessive BarkingNone of the AboveOther
If you listed other, please explain:
At what point would you be willing to take your pet to a professional trainer?
Adoption Commitment & Family Agreement

Confirm your commitment and household agreement.
Is your entire immediate family in agreement with the decision to bring a new pet into your home?

YesNo
If anyone is NOT in agreement, please explain:
Are you prepared to commit to a pet for 10-15 years, or longer?

YesNo
Have you or any member of your household ever been charged with a violent crime, including and especially animal cruelty?

YesNo
If yes, please describe:
How far are you willing to travel to meet and adopt your pet once approved? (In miles)
References

Please provide 3 personal references (only 1 can be a relative). Veterinarians are not accepted as references.
Reference #1: Full Name & Relationship to You
Reference #1 Phone Number
Please enter a valid phone number.
Reference #2: Full Name & Relationship to You
Reference #2 Phone Number
Please enter a valid phone number.
Reference #3: Full Name & Relationship to You
Reference #3 Phone Number
Please enter a valid phone number.
Volunteering

Would you like to help our organization?
Would you consider volunteering for our organization?

YesNot at this time
If yes, which of the following areas interest you? (Select all that apply.)

Temporary Foster CarePersonal interviewing of adoption candidatesFundraisingTransportingHome VisitsRepresenting us at an Adoption EventOther
Are you willing to have a home visit?

YesNo
Additional Information

Is there anything else you think we should know?
If there is anything else you think we should know, please note it here.
Date

MonthDayYear
I certify that all information provided is true and accurate to the best of my knowledge.*

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ADOPTION APPLICATION

Applicant Information

Employment Information

Housing Information

Household Information

Pet History

Veterinarian Information

Adoption Preferences & Readiness

Pet Care and Lifestyle

Adoption Commitment & Family Agreement

References

Volunteering

Additional Information