KSTT Adoption Application Form

Name and/or breed of animal you wish to adopt*

Age of animal you wish to adopt*

Will your adopted animal be an inside or outside animal?

InsideOutside

Applicant's Name*

First NameLast Name

Driver's License Number and State of Issue*

Age*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (Mobile)*

Area CodePhone Number

Phone Number (Work)*

Area CodePhone Number

Phone Number (Home)*

Area CodePhone Number

E-mail*

example@example.com

I / We live in a*

Do you own or rent your home?

Landlord's Name*

Landlord's Phone Number*

Area CodePhone Number

Do you have breed restrictions?*

YesNo

If you have breed restrictions, what are they?

Who will be primary caretaker of animal adopted from KSTT?

Do you have a fenced in yard?*

YesNo

Are there any children living in the home?*

YesNo

If yes, what are the children's ages?

How many adults beside applicant live in your home?

Name and age of all adults living in the home besides applicant.

How many pets live in your home?

Please list Name, Breed, and Age of all animals already at your home.

Are your current pets spayed or neutered?*

YesNo

Are your current pets up-to-date on vaccinations?*

YesNo

Are your current pets up-to-date on heartworm preventative?*

YesNo

Are your current pets receiving monthly flea/tick preventative?

YesNo

Are your pets used to other pets?

YesNoOther

Number of hours (average) pet(s) spends alone*

Where do your animals stay while you are out of the home?

Do you have a regular veterinarian?*

YesNo

Veterinarian's Name or Practice

Veterinarian's Phone Number

Area CodePhone Number

Have you adopted from us before? If so, animal's name. Where is animal now?

Reference 1 - Name*

First NameLast Name

Reference 1 - Telephone*

Area CodePhone Number

Reference 1 - Relationship to adopter*

Reference 2 - Name*

First NameLast Name

Reference 2 Telephone*

Area CodePhone Number

Reference 2 - Relationship to adopter*

Reference 3 - Name*

First NameLast Name

Reference 3 Telephone*

Area CodePhone Number

Reference 3 - Relationship to adopter*

This application is not a binding agreement. Applicant is under no obligation to adopt an animal and Kentucky Saving Them Together Inc. is under no obligation to provide a animal to the applicant. Animals suggested to the applicant based on this application and the subsequent interview and home check may differ from animals listed on this application, as Kentucky Saving Them Together Inc. may believe that different animals are a better match for said applicant. All applications are subject to acceptance based on a review process that requires collecting information from references and visiting the applicant's home. All decisions on placing animals in adoptive and foster homes are based solely on the judgment of the volunteers and coordinators of Kentucky Saving Them Together Inc. Adoption applications submitted through this form may be denied for various reasons. Kentucky Saving Them Together Inc. reserves the right to make all decisions regarding placement or final disposition of any rescued animal in its care whether in, or being placed in, a foster or adoptive home or other facility. By submitting your completed application, you attest that you have read the above disclaimer and agree to the terms therein. Furthermore, you represent that the information you provided on this form is the truth to the best of your knowledge and belief. I hereby forever release, discharge and agree to hold harmless and indemnify Kentucky Saving Them Together Inc, its Board of Directors, and its members, officers and agents from all claims, demands, actions, cause of action or liability of any kind whatsoever arising as a result of or in connection with the fostering or adoption of an animal sponsored by this organization.

If approved to adopt, I agree that if there is ever a problem that I will return the adopted animal to Kentucky Saving Them Together Inc. I am not allowed to dump the animal, abandon the animal, or drop it off at a shelter. I am also not allowed to give the animal away without written permission from Kentucky Saving Them Together Inc. to rehome the animal.

Kentucky Saving Them Together, Inc.

Applicant's Information

Applicant's Current Pet Information

References