Adoption Application Please enable JavaScript in your browser to complete this form.What type of pet are you applying to adopt? *DogCatWhat is the name of the dog or puppy you are interested in adopting? *What is the name of the cat or kitten you are interested in adopting? *CONTACT DETAILS Name *FirstLastAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Drivers License # *ABOUT YOU, YOUR HOME, AND YOUR HOUSEHOLD How long have you lived at your address? *Do you rent or own your home? *RentOwnLive with parentsWhat is the full name of the individual or company listed as the property owner? *Please provide landlord name & telephone number. *What is the name of your apartment complex, condominium association, or HOA? If none, type NONE. *Does this dog fall within the weight and breed restrictions as set forth by your apartment complex, condominium association, or HOA (if any)? YesNoAre you over the age of 21?YesNoAre you over the age of 25?YesNoDoes anyone smoke inside your home? * No, no one smokes inside the home Yes, someone does smoke inside the home Please provide two personal references here (name and phone number, please). *Please list the other members of your household, including children. For adults 18+ please list full name. *Why do you want to adopt this particular dog? Why are you interested in adopting this particular cat? Are you mentally and physically able to take care of this dog? This includes feeding, cleaning up after, bathing, exercising, and taking to veterinary visits. YesNoAre you mentally and physically able to take care of this cat? This includes feeding, cleaning litter, grooming, and taking to veterinary visits. YesNoThe next step in adopting this animal if your application is approved is a home visit, which is just a casual visit to get to know you & discuss dog ownership. Which is your preferred way to do the home visit? * In-person visit FaceTime or Skype visit using phone/computer PET OWNERSHIP HISTORYWill this be your first dog? YesNoWill this be your first cat?YesNoWhat pets do you currently have? *Dog or DogsCat or CatsNo current petsOtherCheck all that applyPlease list and tell us about your current pets. What is the name and phone number of your current veterinarian? If you do not currently have a vet, are you willing to visit one within 14 days of adopting your pet in order to establish a relationship with one? YesNoHave you had pets in the past? *YesNoPlease list any pets you have had in the past and why you no longer have them. Give names and types and why you no longer have them (e.g. deceased, gave away, ran away, etc.) Have you ever turned a cat or dog into a shelter or given a cat or dog away? If yes, please explain.Have you ever had a pet euthanized? If yes, please explain. LIFE WITH YOU Under what circumstances would you give this pet away to a friend or family member? *Expanding human family (e.g. having a baby) Breakup/Divorce Moving Change in economic circumstances (being laid off, etc.) Behavior problems (e.g. barking, scratching furniture, digging, potty accidents) Pet getting sick with an expensive illness Serious aggression issues There are no circumstances which would make me give this dog away Other (please explain below) Check all that applyUnder what circumstances would you surrender this dog to the animal shelter? *Expanding human family (e.g. having a baby) Breakup/Divorce Moving Change in economic circumstances (being laid off, etc.) Behavior problems (e.g. barking, scratching furniture, digging, potty accidents) Pet getting sick with an expensive illness Serious aggression issues There are no circumstances which would make me give this dog away Other (please explain below) Check all that applyPlease make any comments you want to make about your answers to the two previous questions here. How will the dog exercise?Will this dog live indoors or outdoors? How many hours per day will this dog be left home alone? During the time the dog is left home alone, where will s/he spend the time?What will you do if this dog decides s/he prefers chewing on your couch pillows rather than his/her toys? What provisions will you make for this dog should you become unable to care for him or her? List potential reasons that would render you unable to care for this dog. What will you do if this cat decides s/he wants to use your rug instead of the litterbox? What will you do if this cat decides to use the arm of your couch as a scratching post? What provisions will you make for this cat should you become unable to care for him or her? List potential reasons that would render you unable to care for this cat. Will this cat live indoors or outdoors? IndoorsOutdoorsWhat is your plan if you experience an emergency, such as a hurricane? *THE FINE PRINT Do you agree to donate the appropriate adoption fee for this pet? The fee for adoption is indicated on the pet's adoption listing. While this donation does not cover the full medical expenses paid by the rescue, this is the amount agreed as a fair donation. *AgreeDisagreeYou consent to the rescue screening your adoption application, including some or all of the following: checking listed personal and veterinary references; HOA/landlord/complex; and any searchable public record. *AgreeDisagreeYou understand that you are applying to adopt a cat whose medical history is unknown before it entered the rescue. Cats are tested for FIV and FeLV before placement, but beyond that we cannot anticipate future medical problems which may arise. You agree that, as the cat's legal owner, all future veterinary costs are your sole responsibility from the date of adoption. *AgreeDisagreeThe average expense for a cat is $600-1000 in food, litter, and veterinary costs pear year. Do you agree to make such a financial commitment to this cat? *AgreeDisagreeThe average lifespan is 15-20 years. Do you agree that you are comfortable making a commitment to this cat to be its guardian and caretaker for the rest of its life? *AgreeDisagreeYou understand that you are applying to adopt a dog whose medical history is unknown before it entered the rescue. We address all known medical issues when the dog comes into the rescue, but we cannot predict any future medical problems. You agree that, as the dog's legal owner, all future veterinary costs are your sole responsibility from the date of adoption forward. *AgreeDisagreeThe average expense for a dog is $200-2000 in food and veterinary costs pear year. Do you agree to make such a financial commitment to this dog? *AgreeDisagreeThe average dog's lifespan is 10-15 years. Do you agree that you are comfortable making a commitment to this dog to be its guardian and caretaker for the rest of its life? *AgreeDisagreeDo you agree to seek prompt and quality veterinary for this pet as soon as the need arises? *AgreeDisagreeOver-the-counter flea and tick preventatives (Hartz, Adams, etc.) can be extremely dangerous to cats and dogs. Reactions can cause problems such as skin inflammation, seizures, and death. Do you agree to only use veterinarian-approved products such as Revolution, Frontline, Advantage, Capstar, and Program? *AgreeDisagreeWhere did you hear about us? (e.g. Adopt-a-Pet, Craigslist, Facebook, etc) Any additional questions or comments here, please. [ELECTRONIC SIGNATURE] Please type your name here to certify that all of the information contained within this application is true to the best of your knowledge. *Submit
