JR's Pups-N-Stuff Dog Application

Have you, or any members of your household, had a pet in the past 10 years? *

Yes No
Are all pets in the home up to date on vaccines (Distemper & Rabies) as well as heart worm preventatives and annual wellness exams ? *

Yes No
JRs does require that minimally all animals (including indoor cats) have an annual exam, rabies and distemper shots as well as annual wellness exams including HW test. Titter testing can be done in lieu of annual vaccines.
What type(s) of pets do you own or have owned in the last 10 years? Please list ALL household pets. If you no longer own the pet, please be specific as to what happened to the animal. If you have an unneutered dog/cat, please explain why you have not altered the animal.
Who is (was) your veterinarian for the above aniamls? If your pets see different vets, please list all vets you are using/used. (Applications will NOT be processed without this information) You MUST contact your vet and let them know that they can release information to our representative. Failure to do this will result in significant delays in processing your application.
If this is your first pet, how do you plan to pick a veterinarian?

Comments or additional information you would like to provide to assist us in identifying the correct dog for you.
What is your desired time frame for adopting? *
How did you hear about us?

Friend/Family referral Petco Adoption Event Online pet search engine (Petfinder, Petango etc) Facebook
By signing below, I certify that the information I have given is true and I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting a pet. I authorize investigation of all statements on this application. Verification of vetting, landlord and available public records will be checked for accuracy of information. I understand that this application is property of the JR’s Pups-n-Stuff.
Signature: *
(Typed or electronic signature accepted)
Today's Date *

/ Month / Day Year
Date
Should be Empty:

JR’s Pups-N-Stuff Rescue