ARVSS Pet ADOPTION Application Form

ARVSS Pet ADOPTION Application Form

Animal Rescue & Vet Support Services
Perspective Pet Parent*

First NameLast Name
Birthdate*

MonthDayYear
Date
Email Address*
example@example.com
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list the names of ALL adults living at this residence.*
Provide the number of family members/roommates at your residence. Please list the ages of children.*
Do you rent, own or live in a condo? We verify home ownership or get approval from your landlord. *
We do this because one of the top 10 reasons unwanted animals are surrendered is "Landlord does not allow pets."
Please provide your landlord's or condo association's contact information.*
Include name and phone number
Name of the pet you wish to adopt.*
If the pet you wish to adopt is no longer available, please let us know what you are looking for and we will try to find a match for you.*
Example: breed, sex, age
Why do you want to adopt a dog or puppy?*
Where did you hear about ARVSS? *
Example: name of website or social media, Meet & Greet, name of event
Indicate and describe your current pets. List other pet you have owned.*
Are your pets up to date on all vaccinations (rabies, bordetella, distemper)? If no, please explain.*
Are your pets up to date on heart worm prevention? If no, please explain.*
Are your pets spayed or neutered? If no, please explain.*
Have you ever surrendered or re-homed a pet? If yes, please explain.*
Vet's name, clinic and phone number. Please list the name used at the vet clinic so they can locate your records.*
PLEASE NOTE WE WILL CALL YOUR VET TO VERIFY SHOT RECORDS AND CARE.
Do you have a yard?*

YesNo
Is it fenced? please describe
Where will the dog be kept? (fenced yard, in house, crated when alone, daycare while at work, etc.)*
Do you plan to take your dog to obedience class?*
Are you familiar with the licensing requirements in your community?*

YesNo
3 Personal References (not family members or people in your home)*
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo
Please provide a detailed description:
A dog may live for 10 to 15 years and will need your committed care for the dog's lifetime. Animals can be expensive to care for. The estimated annual average for one dog is $1,400 to over $3,000. Are you willing and able to provide adequate food, shelter, and medical care, including yearly check-ups and vaccinations for an adopted dog? ARVSS is not responsible for extraordinary medical costs your pet may require after the adoption.*

YesNo
By clicking the submit button:
- I certify that the information I have given is true and accurate.
- I understand my references will be checked including veterinary and personal.
- I understand there is an adoption fee associated with the adoption of a pet and I understand this donation will ensure the organization is equipped to rescue another homeless pet.
- I realize that any misrepresentation of facts may result in my losing the privilege of adopting an animal from ARVSS.
- I understand that ARVSS has the right to deny my request to adopt an animal for any situation that would be contrary to the organization's adoption policies, in violation of any state or local ordinances, or not in the best interest of the animal, as determined by ARVSS.
- I authorize verification of all statements in this application, and I also authorize my veterinarian to release any information requested by ARVSS.
Date*

MonthDayYear
Date
Signature of Potential Pet Parent*

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