Adoption Application v 3.23

OKIE PET RESCUE PET ADOPTION APPLICATION
Name*
Phone*
Format: (000) 000-0000.
Address*
City*
State*
Zip*
E mail Address*
example@example.com
Employer
Name of Pet Applying For*
Type of Pet

DogCatOther
I am 18 Years of age or older.*

YesNo
Is this pet specifically for your household?*

YesNo
Is this pet a gift?*

YesNo
Do you have pets now?*

YesNo
How many Cats
How many Dogs
Other Pets
Are all of your pets spayed/neutered?*

YesNo
Reason Why?
Are all of your pets vaccinated?*

YesNo
Reason Why?
Do you use heartworm prevention?*

YesNo
which medication?
What will you do if your new pet does not get along with your current pet(s)?
Do you live in a:

HouseApartmentOther
Within City Limits?*

YesNo
Do you rent?

YesNo
Yes, Landlord's name
Contact Phone
Format: (000) 000-0000.
Number of adults in household
Age of each child
This housed is:

SmokingNon-Smoking
The pet will be

IndoorIndoor/OutdoorOutdoor
Do you have a fenced yard?

YesNo
Height
Type
How will you guarantee the pet will stay home?
Are you prepared to spend $380 - $1,170 annually for a dog or $430 - $870 for a cat

YesNo
Veterinary Clinic*
Phone*
Format: (000) 000-0000.
Name of pet(s) treated*
Please read carefully before signing.

The information given on this application is true correct to the best of my knowledge. I authorize my veterinarian to release information to OPR for the purpose of processing and evaluating this application. I understand that this application is to help determine if the proposed adoption is in the best interests of both the pet and me/my family, especially if there are young children in the residence. I understand that submission of this application, under no circumstances, ensures my approval for adoption.
Signature
Date

MonthDayYear
Date
Should be Empty:

OKIE PET RESCUE PET ADOPTION APPLICATION