Adoption Application

All potential adopters and foster homes are screened for suitable placement of animals.
RT4P reserves the right to refuse placement of an animal for any reason.

Must be 25 years or older with identification showing present address.
Must have the knowledge and consent of all adults living in the household.
Must receive proof of pet deposit and lease allowing pets if renting.
Must be able and willing to spend the time and money necessary to provide training, medical treatment and responsible care for a pet.
All applicants must be residents of the Dallas/Fort Worth Metroplex

At least one item listed below is a Required Answer

Rows	Dog	Cat
What pet are you interested in adopting?

Name(s) of pet(s) you are interested in adopting:

APPLICANT INFORMATION

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Employer

Age

Cell Phone

Area CodePhone Number

Other Phone

Area CodePhone Number

E-mail

Driver License Number

Pet Information

All items listed below are Required Answers

Rows	Yes	No
Have you owned a pet before?
Have your current or former cats been declawed?
Do you plan to declaw your cat?
Do you plan to spay/neuter your pet?
Have you adopted from a rescue organization before?

If yes, name of rescue organization:

Required Answer

Rows	Yes	No
Have you ever surrendered a pet to a shelter or re-homed a pet?

If yes, please explain:

Rows	Yes	No
Have any of your current pets had medical problems in last 12 months?

Description of medical problem(s):

Pet Behavior

Are you willing to work through the following behaviors? (all are Required Answers)

Rows	Yes	No
Digging
Jumping
Chewing
Accidents in the House/House Training
Anxiety
Clawing

Rows	Yes	No
Would you seek help from a trainer if the pet you adopt develops a behavioral problem?

Home

Required Answer

Rows	House	Apt	Condo	Mobile Home
Your Type of Residence

How long have you lived at this address?

All items listed below are Required Answers

Rows	Yes	No
Do you have a doggie door?
Do you plan to move soon?
Does your home have a fenced yard?

Height of fence

Type of fence

Where will your pet be kept during the day?

Where will your pet be kept at night?

Hours you spend away from home each day:

If Rented:

Can you provide proof of pet deposit paid?

Name of apartment complex:

Landlord name:

Landlord phone number:

Weight or size restrictions:

Veterinarian Information

All items listed below are Required Answers

Rows	Yes	No
Do you have a veterinarian?
May we contact your vet?
Are you prepared to accept the expenses of yearly booster shots and proper care for 10 – 20 years?
Do you purchase heartworm prevention outside of your vet's office?

If Yes to the last question above, please indicate where you purchase the heartworm preventative medication

(If you answered "No" above, you do not have a veterinarian, please enter "N/A" in the two fields below for Vet Name and Phone.)

Vet Name:

Vet Phone Number:

Current Pet Names:

What name(s) are vet records listed under for your current and former pets?

Information on Current Pets in the Home

All items listed below are Required Answers

Rows	Yes	No
Are/were current and former pets spayed or neutered?
Are/were current and former dogs up to date on heartworm preventative?
Are/were current and former pets up to date on vaccinations?
Are/were your cats allowed outside?
Are/were your current and former pets microchipped?
Are/were your current and former pets on flea/tick preventative?

Number of Dogs you currently own:

Breeds:

Number of Cats you currently own:

List all pets owned in the last 10 years (including current pets)

Rows	Dog/Cat	Breed	Age	Owned Now?	If no, why?
1
2
3
4

Rows	during the day?	during the night?
Where were former pets kept?

Family Information

All items listed below are Required Answers

Rows	Yes	No
Anyone with Dog allergies in the household?
Anyone with Cat allergies in the household?
Are you a student?
Do you travel frequently?

If so, who cares for your pets?

# of Adults in Household

Ages

# of Children in Household

Ages

Who will care for your pet in event of your death?

Relationship

All items listed below are Required Answers

Rows	Yes	No
Are you adopting this pet as a gift?
Do all adults support the adoption of a new pet?
Do you agree to return the pet to Road Trip 4 Paws if you cannot keep him or her and notify us if the pet is lost?
Do you agree that the adoption fee is a non-refundable donation to Road Trip 4 Paws?

Who will be the primary caregiver of the pet?

If your financial or living situation were to change, what would happen to your pet?

Signature

Road Trip 4 Paws performs home checks to ensure the suitability of the pet to the home, and to check for potential dangerous circumstances. By signing this document, you agree to allow Road Trip 4 Paws to conduct a home check.

Type your name to sign

Date

MonthDayYear

E-mail

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