Adopt Application

Date

Pet Name

Person 1 Name*

PrefixFirst NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone*

Area CodePhone Number

Cell Phone*

Area CodePhone Number

E-mail*

Person 2 Name

PrefixFirst NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

E-mail

example@example.com

Please supply a list of all adult’s name and age who live in the house:

Do you have children?

YesNo

Child #1 Name

Age

Experience with Pets?

YesNo

Child #2 Name

Age

Experience with Pets?

YesNo

Child #3 Name

Age

Experience with Pets?

YesNo

Do you..

Own your home?Rent your home

Do you have authorization in your lease, rental, or homeowner's association contractto have indoor and outdoor pets?

YesNo

Landlord, Manager or HOA Contact:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone

Area CodePhone Number

Cell Phone

Area CodePhone Number

Email

example@example.com

Veterinary Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

How many pets have you had in the past?

Have you ever had to give up one of your pets?

YesNo

If yes, please explain in detail

Do you have pets now?

YesNo

If yes, please provide Pet #1 's name

Species/Breed

Indoor?

YesNo

Sex

MaleFemale

Age

Vaccinated?

YesNo

Altered?

YesNo

Pet #2 's name

Species/Breed

Indoor?

YesNo

Sex

MaleFemale

Age

Vaccinated?

YesNo

Altered?

YesNo

Pet #3 's name

Species/Breed

Indoor?

YesNo

Sex

MaleFemale

Age

Vaccinated?

YesNo

Altered?

YesNo

Reference #1 Name

First NameLast Name

Phone Number

Area CodePhone Number

Relationship

Reference #2 Name

First NameLast Name

Phone Number

Area CodePhone Number

Relationship

Do you have a secure fenced backyard?

YesNo

How high is the fence?

How long will you be away from your pet on a daily basis?

What will you do with your pet while you are gone?

How will you exercise your pet?

Where will your new pet sleep at night?

What do you think makes this particular pet a good choice for you?

Have you had experience with this particular breed?

Are there any other comments you would like to add?

I certify that the above information is true and accurate to the best of my knowledge, and that I have willingly provided it to Casa de
Love Animal Rescue. I will notify Casa de Love Animal Rescue of any changes related to this information.

Signature of Applicant*

Date Signed*

Date

Print Name*

First NameLast Name

Signature of Co-Applicant

Date Signed

Date

Print Name

First NameLast Name

Signature of CLAR representative

Date Signed

Date

Print Name

First NameLast Name

Adoption Application