Pet Adoption Application Form

Perspective Pet Parent*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Name of Pet You Wish to Adopt*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you own any pets?

YesNo

Pet Name(s)

Pet Breed(s)

Pet's disposition and behavior towards other dogs?

Veterinarian Name

First NameLast Name

Veterinarian Phone Number

Please enter a valid phone number.

Do you own or rent your home?*

OwnRent

Please provide your landlord's information here:*

Do you have a yard?*

YesNo

Is it fenced? please describe

What is your landlord's pet policy?*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

Are there children in the home? (If yes, please list ages)*

How many hours per day would the pet be alone?*

Will you crate your pet?*

If you have to leave town, emergently or planned, where would your pet stay?*

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?*

3 Personal References

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

Please provide a detailed description:

By clicking the submit button, I agree to go adoption process, will undergo a homecheck, and interview.
By clicking the submit button, I understand my references will be checked including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, I understand there is no "cooling off" period, and that if I no longer want or can no longer care for my adopted pet, I agree to notify Rescue Center. BY EMAIL and provide a 14 day period to allow Rescue Center to make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless the rescue center against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that Rescue Center will disclose any of the pet's health or behavior issues known by the above named rescue group before adoption is completed.
By clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to Rescue Center and provide transport to where Rescue Center deems appropriate.
By clicking the submit button, I verify all of the above information is true and accurate.

Date

Signature of Potential Pet Parent