Age
Occupation
Cell Phone
Business Phone
Home Phone
Please tell us about your co-applicant (spouse or significant other), if applicable
Name
Animal(s) of Interest
What is the name of the animal(s) you are interested in?
List any general questions you have about this pet
May a representative from the rescue group visit your home by appointment?
Please check any of the following reasons for adopting this pet
Other reasons for adopting
Please tell us about your home
Please indicate where you live
Do you
If you rent, what is the landlord/complex phone number?
How much is the pet deposit?
How many times have you moved in the past 5 years?
Do you foresee any major changes in your life in the next 15 years
If yes, please explain
Do you have a fully fenced yard?
If yes, please describe the type of fence and height
How many adults are in your household?
Does anyone in the household smoke?
Will this pet be a surprise for any family members?
If yes, for whom?
Do any family members have allergies?
Do children live in the house?
If yes, what are their gender/age?
Please tell us about your current pets and pet experience
Number, type and age of pets currently in household
Do any of your current pets or did any of your past pets live primarily outdoors?
If yes, please describe outside pets
Were all your previous pets spayed/neutered?
Are all of your current pets spayed/neutered?
Do you know what heartworm disease is and how to prevent it?
Do/did you use heartworm prevention?
What brand of heartworm prevention do/did you use and how often?
How do you plan to prevent fleas and ticks?
If you are applying for a cat, do you plan to declaw your new cat/kitten?
Have you always kept an ID tag with your phone number on your pet(s)?
Please describe what happened to each of your past pets (put to sleep, run over, died of old age, sold, given away, ran away, etc.)
What is your Veterinarian's name and phone number?
How many hours will your pet be home alone on a typical day?
Where does your current pet stay when home alone during the day?
Where will your new pet stay when home alone during the day?
Where do your current pets sleep at night?
Where will the new pet sleep at night?
What % of time will the pet spend indoors?
Do you have a pet door?
Under what circumstances do you think it is safe to leave a dog/cat outside alone or unsupervised in an unfenced area?
What circumstances, in your mind, justify giving a pet up?
Other reasons for giving up pet
Have you ever given a pet up or had a pet and it didn't work out?
If you have given up a pet, please explain the circumstances and what happened to him/her
Have you ever looked at or applied for a pet with another shelter or rescue group?
Did you adopt?
If so, how long ago?
Has a dog, puppy, cat or kitten died on your premises in the last 6 months?
Please list the names, addresses and phone numbers of 2 personal references
Which shelter/rescue group?
What type of food will you feed your pet(s)? (Brand Name)
Verification Statement