Pre-Adopt Application

Applicant Information
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Name of adoptable pet or desired characteristics*
Reason for adopting*
Household Information
Name and ages of all individuals in the household:*
Name of primary caretaker*
Will anyone be adversely affected by a new pet?*

YesNo
If yes, please explain:
Do all family members wish to adopt a pet?*

YesNo
Do you rent or own your home?*

RentOwn
How long have you lived there?*
Do you anticipate moving in the next 10-15 years?*

YesNo
If you rent, are you allowed to have pets?*

YesNoN/A
Landlord's Name and Phone Number
For dogs: Do you have a fenced yard? If so, type/size/height of yard and fence:
Where will your new pet stay during the day? At night?*
How do you plan to provide daily exercise your new pet?*
Current/Previous Pet Information
Please provide breed, name, gender, and age of all current pets:*
Are all of you current pets spayed/neutered?*

YesNoN/A
Have all current pets been vaccinated within the past 3 years?*

YesNoN/A
If the answer to either of the questions above was "no", please explain why.
Do all current pets get along with other animals?*

YesNoN/A
Have you had pets in the past? If so, what happened to them?*
Name and phone number of regular veterinarian: *
Are you prepared to care for this pet during the ENTIRETY of his/her life? Including regular annual expenses for vaccinations/preventative care/training and any required emergency care?*

YesNo
For cats: have you read, and do you understand the information provided regarding upper respiratory infection and coccidiosis?*

YesNoN/A
Character References
Reference #1*
Phone Number*

Area CodePhone Number
Email Address
Best time to contact*

MorningAfternoonEvening
Reference #2*
Phone Number*

Area CodePhone Number
Email Address
Best time to contact*

MorningAfternoonEvening
As a pet adopter, you will be expected to:
Pay a non-refundable adoption fee*

YesNo
treat your new pet as a companion and provide them with a safe and loving environment*

YesNo
refrain from allowing dogs to be chained outside for prolonged periods of time or ride loose in the back of a pick-up truck*

YesNoN/A
respect the "indoor only" requirement of our feline adoptions*

YesNoN/A
keep your new pet up-to-date on vaccinations, requiring yearly vet visits*

YesNo
never subject your new feline companion to being declawed*

AgreeNoN/A
allow DunRoamin' to perform home visits to check on the welfare of the adopted pet*

YesNo
respect that if the adopted pet is being treated inhumanely or there is a breach of contract, DunRoamin' will re-possess them immediately*

YesNo
recognize that DunRoamin' does not guarantee or provide warranties for the future health or temperament of your new pet and, upon adoption, you will be responsible for their long term care*

YesNo
agree that DunRoamin' assumes no liability or responsibility of any nature regarding later defects with the pet or injuries or damage to any person or property cause by the pet*

YesNo
never, under any circumstance, transfer ownership of the pet to someone else. The pet is to return to DunRoamin' if you are no longer able or willing to care for them*

YesNo
commit to your new rescued pet for the entirety of their lives*

YesNo
Please provide additional comments:
Statement and Signature
I agree that all statements I have made on this form are true. If it is found that any statements I have made on this form are not true, the adopted animal may be confiscated by DunRoamin' Stray and Rescue.
Digital Signature*
Date*
Should be Empty:

Applicant Information

Household Information

Current/Previous Pet Information

Character References

As a pet adopter, you will be expected to:

Statement and Signature