Pet Adoption Application Form

Perspective Pet Parent

First NameLast Name

Email Address

example@example.com

Phone Number

Format: (000) 000-0000.

Name of Pet You Wish to Adopt

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Are you open to another dog if this one is not a right fit

If yes, what traits are you looking for

Veterinarian Name

First NameLast Name

Veterinarian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you own or rent your home?

Please provide your landlord's information here:

Type of residence

Do you have a yard?

Is it fenced? please describe

What is your landlord's pet policy?

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?

Are there children in the home? (If yes, please list ages)

Are you open to special needs

How many hours per day would the pet be alone?

Will you crate your pet?

If you have to leave town, emergently or planned, where would your pet stay?

Are you planning on moving in the next 12 months

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?

3 Personal References

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?

Please provide a detailed description:

How did you hear about us?

After this application is filled out, it will go under review. If everything looks good, we will contact the applicant to schedule a meet and greet with the dog.

By clicking the submit button, I agree to the adoption process and interview.
By clicking the submit button, I understand my references will be checked including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I agree to indemnify and hold harmless the rescue center against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Rescue Center will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I verify all of the above information is true and accurate.

Date

Signature of Potential Pet Parent