Adoption Application

Name of animal you are you interested in adopting?*

Your Name*

First NameLast Name

Your Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Your Home Phone *

Area CodePhone Number

Your Cell Phone*

Area CodePhone Number

Your Email*

I certify I am over 21 years old*

YesNo

Date of Birth*

Drivers License Number*

Employer*

Employer Address*

Employer Phone Number*

If approved, the dog I am interested in, will be a member of my household. I am not applying for someone else.*

I agreeI am applying for someone else

Does anyone in your home smoke?*

YesNo

Names of all permanent residents of your household*

Ages of all permanent residents of your home (adults/children)*

Please list any pets (species/breed/age/sex) currently living in your home*

Are your pets:*

AlteredUTD on vaccinesOn monthly heartworm and flea/tick preventativeNone of the above

Name of current veterinarian - (please call your vet and give notice that we will call). If you do not currently have a vet, we require proof of a vet appointment within one week of adopting, along with proof of heartworm preventative)*

Vet Address*

Vet Phone*

Is anyone in your home allergic to the animal you're planning to adopt?*

YesNoYes, but it is tolerable for them and they are OK with it.

Do you live in a:*

Do you rent or own this property?*

RentOwn

If you rent, you must provide a signed letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have this type of animal there and show any restrictions.

Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)

Do you have a pool?*

Is the pool fenced?*

If your pool is not fenced, how will you ensure the safety of your adopted pet?*

Do you plan on crating your adopted dog?*

How many hours per day will your dog be crate?*

Do you plan on keeping your dog on Heartworm preventative?*

Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.

What will a typical day look like for your dog (please be specific)?*

How will you exercise your adopted dog, and how often?*

Where will your new pet be kept during the day?*

IndoorsOutdoorsCrated

Where will your new pet sleep at night?*

IndoorsOutdoorsCrated

Will your new pet be kept outdoors?*

DaytimeOvernightNever

How many hours a day will your new pet be left alone?*

If applicable, will your children be taught how to play gently and kindly with this animal?*

YesNoNo children

Do you (or anyone in your household) have any special health conditions/limitations, allergies or special needs that we should consider, when finding you the right match?*

What method(s) would you use to reprimand your dog?

What plan do you have in place for your new pet, in the event something should happen to you?*

What happens if your new pet bites or nips someone?*

Additional references (if desired)

Do you have any additional comments, questions or concerns?*

By checking the box below, you understand the terms of this form and adoptee. You hereby agree that you will not use this animal in any sort of fighting, breeding, or cruelty. You will love and care for this animal for the rest of its life, and you are ready to commit to that. You also agree, that if for any circumstances you can no longer provide love and care for this animal, you will contact SALVAGED SOULS PET RESCUE, explain your situation and agree to relinquish the animal back to SALVAGED SOULS PET RESCUE, and not take the animal to the shelter.*

I understand the above, and have tried to the best of my knowledge to make sure all information is correct.

Adopter's Signature*

Signature date*