Pet Savers Rescue Adoption Application

Name of Pet you are interested in Adopting

Name

First NameLast Name

Date of Birth (must be at least 18 years of age)

Phone Number

Area CodePhone Number

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long at this address?

Place of Employment

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Work Phone Number

Area CodePhone Number

How long at this job?

How did you hear about us?

Why do you want to adopt this dog/cat?

What type of dog/cat are you looking for?

Who made the decision to adopt a pet?

On a scale of 1-5 (with 5 being highly energetic and 1 being very quiet), what activity level are you looking for in a dog/cat?

How many hours per day will this pet be home alone?

Where will you keep this pet when home alone?

Where will this pet sleep?

What percentage of time will this dog/cat spend inside/outside?

What type of housetraining techniques will you use?

How much do you think food, supplies, vet care, etc. will cost monthly?

What would you do if your pet required an expensive veterinary procedure?

Please enter age and type of pets you currently have in your household

How many pets in the household?

Pet's Name

Pet's Species

Pet's Breed

Male or Female?

Spayed or Neutered?

Pet's Age

Inside or outside Pet?

Pet's Name

Pet's Species

Pet's Breed

Male or Female?

Spayed or Neutered?

Pet's Age

Inside or outside Pet?

Pet's Name

Pet's Species

Pet's Breed

Male or Female?

Spayed or Neutered?

Pet's Age

Inside or outside Pet?

Pet's Name

Pet's Species

Pet's Breed

Male or Female?

Spayed or Neutered?

Pet's Age

Inside or outside Pet?

Pet's Name

Pet's Species

Pet's Breed

Male or Female?

Spayed or Neutered?

Pet's Age

Inside or outside Pet?

Where do your current pets sleep?

Where do your current pets stay when home alone?

Under what circumstances do you feel it is OK to let a dog outside unattended?

What type of ID do you have on your current pet(s)?

How many pets have you owned in the last 5 years?

Where are those pets now?

What, in your opinion, would be a reason for giving up a pet?

What type of behavior problems have you had with previous pets?

How did you correct those problems?

Suppose your pet develops a frequent urination problem at age 12. You work 8 hours a day and they can’t hold it that long. What would you do?

Have you ever surrendered a pet to a shelter, other agency, or another person?

If yes, please explain

Does anyone in your household have allergies?

If yes, who and to what is the family member allergic?

If you are dating and plan to marry someone who does not want your pet what would you do?

Do you Own or Rent your home?

If you do not own your home, please provide the name, address, and phone number of your landlord. (We will need to see a copy of your lease agreement).

Landlord

First NameLast Name

Landlord's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Landlord's Phone Number

Area CodePhone Number

Does your landlord require a pet deposit and/or a monthly pet “fee”?

If you have moved frequently, please explain why

You have to move to an apartment/rental/nursing home that does not allow pets. What would you do?

What are the behaviors/traits that would cause you to not keep your pet for the rest of his/her life?

Number of adults in the household

Name & Relationship to you

Do you have children in the household?

If so, please provide first name and ages/genders:

Age & Gender

Do you have a fenced yard?

What type of fence

WoodChain LinkVinylOther

Approximate Height of Fence

If no, what will you do for the animal’s elimination and exercise requirements?

If you had to be away for a lengthy period of time (vacation, emergency or work travel), who will take care of your dog while you are away?

Your veterinarian’s name

Veterinarian's Phone Number

Area CodePhone Number

Veterinarian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do we have permission to contact your veterinarian?

References: (Please list three personal references whom we may contact)

Name

First NameLast Name

Phone Number

Area CodePhone Number

Relation to you

Name

First NameLast Name

Phone Number

Area CodePhone Number

Relation to you

Name

First NameLast Name

Phone Number

Area CodePhone Number

Relation to you

Do we have permission to contact your references?

Would you agree to a home visit by a representative of our organization?

Additional Information:(Anything else you would like to tell us?)