Online Application
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Online Application
Full Name
Complete Address
Home Phone
Work Phone
Occupation
E-Mail Address
Are you over 18?
Yes
No
Name of the pet you are interested in
Number of adults in the home
Number of children in the home
Ages of the children in the home
Do you own or rent?
Own
Rent
Landlord's name/number
Do you currently own any pets?
What types of pets do you own?
Are your current pets spayed/neutered?
Are your current pets indoors or outdoors?
Please list any pets in the last five years you no longer have, and the reason why.
Where will your pet spend most of the day?
Where will your new pet sleep?
How many hours a day will your new pet have to spend without human contact?
Do you realize it can take up to two weeks for the average pet to adjust to its new home?
What are some favorable characteristics you would like to have in your new pet?
What types of characteristics would you not be able to deal with in your new pet?
Do you know that pets require veterinary care, yearly vaccinations, and monthly worming?
Do you know about heartworm; the test and monthly preventative pill for the disease in dogs?
Please notify your current veterinarian(or last veterinarain) that we will be contacting them and give permission for them to verify any of your past or currents pets medical records. Please provide vets name and phone number.
Are you willing to make a full commitment to your new pet, emotionally, physically, and financially?
Any addition information you would like us to consider in reviewing your application.
By typing my name in the box provided, I agree that all of the information that I have provided above is true and complete to the best of my knowledge, and do hereby give a representative of the rescue group permission to check my references I have listed. Should an animal be placed with me, it will reside in my home and be my responsibility.
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