New Beginnings Animal Rescue

New Beginnings Animal Rescue

Adoption Application
Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.

The following questionnaire has been designed to aid both you and the adoption coordinator in deciding if you and/or your family are adequately prepared to assume the responsibility of pet ownership.

Please be sure to ANSWER ALL QUESTIONS. If a question does not apply type N/A.
Please verify you are applying to adopt a pet from New Beginnings Animal Rescue based in Olive Branch, MS

YesNo
Today's Date

MonthDayYear
Name of Pet You Wish to Adopt*
Are you interested in adopting*

CatDog
To apply for a RABBIT please go to NBAR RABBIT APPLICATION
Are you 21 or over?*

YesNo
ADOPTER'S GENERAL INFORMATION
Primary Adopter Full Name*

First NameLast Name
Primary Adopter Age*
Ages
Primary Mobile Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Adopter Full Name*

First NameLast Name
Secondary Adopter Age*
Ages
Secondary Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
E-mail*
Primary Adopter Employer*
Primary Adopter Occupation*
Primary Adopter Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Adopter Employer*
Secondary Adopter Occupation*
Secondary Adopter Work Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Best Time to be Contacted*
PET INFORMATION
Do you currently own pets?*

YesNo
If you answered Yes, list current pets names, breeds, sex, pet's ages: *
type n/a if no pets
VETERINARIAN INFORMATION
Please list your veterinarian for present and past pets. NBAR will contact them to verify all vetting and if pets were altered and up to date on all vetting; this is a requirement for new pet adoptions. Please call their office(s) to authorize release of information to New Beginnings Animal Rescue. If you are planning to utilize another vet but are not currently a client, please note that information.
If you don't have pets now, please list past pets you have owned in the past five years, indicating name, breed, sex, pet's age, and what happened to them.
Veterinarian Name and Information to contact them*
Please list name of person your pets records are under.*
If you currently do not have a veterinarian please list who you are planning on using
REFERENCES
Please provide two references that are have no relation to you. Please advise them a NBAR volunteer will be contacting them so they can expect our call/email:
Name Personal Reference #1*
Name Personal Reference #1:
Relationship of Referencce #1*
Phone Number Ref 1*
Format: (000) 000-0000.
Email of Personal Ref 1
example@example.com
Name Personal Reference #2*
Name Personal Reference #2
Relationship of Reference #2*
Phone Number Ref 2*
Format: (000) 000-0000.
Email of Personal Ref 2
example@example.com
ADDITIONAL INFORMATION
Why do you want to adopt at this time?*

Companion for you/family/another petGuard DogGiftOther
If adopting a CAT, do you plan to declaw*

YesNoN/A because I am adopting a dog
If adopting a CAT, do you plan to keep*

Inside OnlyInside/OutsideOutside OnlyKeep as Barn Cat
Do you have a fenced yard?*

YesNo
Type of Fence?*
Height of Fence?*
Do you have a...*

BalconyPoolPet DoorUnscreened WindowsElectric FenceNone of the above
Is anyone home during the day?*

YesNo
How many hours will the pet be left alone?*
Where will your new pet stay at night?*
If adopting a CAT, where will the litter box go?*
Do you travel?*

YesNo
Where do your pets stay if and when you travel?*
PROPERTY/HOUSEHOLD INFORMATION
Please list the name, age and relationship to yourself of each person currently living in your house (example- Mary, spouse 35) *
Occupancy*
Own/Rent/Live with parent
Type of Home*

housecondomobile homeduplexapartmentOther
How long at current address?*
Do you plan to move within the next 6-12 months?*

YesNo
Are you willing to have a NBAR volunteer do a home visit?*

YesNo
Name of Landlord*
Landlord's Phone*
Please enter a valid phone number.Format: (000) 000-0000.
If you rent are pets allowed? Please call to verify and to notify your landlord we will be calling to verify all information. Thank you!*

YesNo
Pet Deposit?*

YesNo
How much is your non-refundable pet deposit per pet?*
Is there an increase in your monthly rent?*

YesNo
Do all parties in the household want a pet?*

YesNo
Which of the following situations would lead you to give away your pets?*

Moving to another stateHaving a babyRuins the furnitureToo expensiveGetting a divorce or marriedGrew too bigWould not give up for any reasonFleas or sheds too muchFinished school/moving back homeChildren will no longer care for petAllergiesFound a new "no pet" rentalDigging/ChewingOther
What would you do with your pet if you could not keep it for the reasons stated above?*
Have you ever surrendered a pet to a shelter/pound?*

YesNo
If yes, why?*
How do you discipline a pet?:*
How much do you believe the annual expenses for this animal will be?:*
Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring for pet? If yes, please provide name, address, phone number and relation.*
Do you have the time to provide adequate love and attention to a pet?:*

YesNo
Do you agree to provide healthcare for your pet if it gets sick?*

YesNo
Do you agree to keep a dog on heart worm and flea prevention?:*

YesNo
Do you agree you will provide adequate food, water, and annual vaccinations for this pet?:*

YesNo
Has anyone in your household ever been accused or convicted of animal abuse, cruelty or neglect?:*

YesNo
Do you agree that all the information you have given is true and accurate?:*

YesNo
Is there anything else you would like to tell us that you think would be important when considering your application?*
PLEASE READ AND SIGN BELOW:

Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit their individual needs. Please ask for clarification if you have any questions.
Primary Adopter*
Primary Adopter
Secondary Adopter*
Secondary Adopter
***Before you push submit, please be sure you filled in all required areas *. If the question does not apply to you please mark NA. If any questions are left blank the form will not be completed and we will not recieve the form.
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