satchels_Adoption18

I am interested in adopting:*
Name of animal interested in (if applicable)
Reason for adopting:*
Have you ever adopted from us before?*

YesNo
If yes, when
ADOPTER INFORMATION
Full Name*

First NameLast Name
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer*
Work Phone

Area CodePhone Number
Employer Phone

Area CodePhone Number
Driver’s License # *
State*
Are you a full-time FL resident?*

YesNo
What other state do you reside in?
Have you ever been charged with or convicted of animal abuse, neglect, or cruelty?*

YesNo
If yes, explain
CURRENT LIVING ARRANGEMENTS
Current Living Arrangement*
Do you *

OwnRent
Landlord’s Name
Landlord’s Phone

Area CodePhone Number
How many adults are there living in the home where this pet will be? *
How many children? *
Ages
Is anyone in this household allergic to animals?*

YesNo
Do you have a backyard? *

YesNo
Is it fenced on all sides?

YesNo
Height of fence
Type of fence
Do you have a pool? *

YesNo
Is there a fence around the pool?

YesNo
CARE OF YOUR NEW FAMILY MEMBER
Will someone be home during the day with this pet? *

YesNo
Who?
How many hours each day will this pet be without human companionship?*
What sort of training do you plan/are willing to provide for this pet? (crate training, obedience class, etc.) *
How do you plan to exercise this pet? *
Where will this pet be kept during the day?*
Where will this pet sleep?*
If adopting a dog, will he/she be kept
If adopting a cat do you intend to declaw him/her?

YesNo
Will this cat be
If you drive a pickup truck, would you allow this pet to ride in the back? *

YesNo
Under what circumstances would give up this pet? *

Excessive expensesGot too bigNot enough time to spend with petToo energetic/hyperChewingDiggingBitingMovingNone of the Above
Do you travel? *

YesNo
How do you intend to provide for this pet while you’re away?
What provisions will you make for this pet should you become unable to care for him/her? *
Are you willing to have a representative of Satchel’s Last Resort come to see where this pet will be living?*

YesNo
Why not?
Do you understand and agree that should you be approved for an adoption and it does not work out that this pet MUST be returned to Satchel’s Last Resort ? *

YesNo
OTHER PETS
Do you currently have pets?*

YesNo
If yes, please list type of animal, sex, age, if the animal is spayed/neutered, current on all vaccations and Heartworm prevention.
Animal Type, Sex, Age, Spayed/Neutered, Current on Vaccations and Heartworm prevention
Have you had pets in the past?*

YesNo
What happened to them?
Have you ever turned a pet into a shelter?*

YesNo
Please explain
Have you ever had a pet euthanized? *

YesNo
Please explain
REFERENCES

Give three references (two non-family members), and veterinarian
Reference One*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
Reference Two*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
Reference Three*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship*
If you have used a vet in the past
Veterinarian’s Name

First NameLast Name
Phone Number

Area CodePhone Number
Name and type of animal registered with this clinic
Name of owner

First NameLast Name
If you never have had a pet, please give us the name and number of the vet you are planning to use.
Veterinarian’s Name

First NameLast Name
Phone Number

Area CodePhone Number
COMMENTS
Satchel’s Last Resort reserves the right to reject any application for adoption. Applicant, by signing below, gives permission for a representative of Satchel’s Last Resort to contact references and landlord (if applicable) provided on this form, and make a home visit prior to adoption. Applicant further acknowledges that all information contained in this application is true and correct, and that any misrepresentation may result in the removal of the adopted pet if adoption is approved. Applicant understands there is an adoption fee due at the time of adoption.
Applicant's Signature*

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