| Full Name | |
| Complete Address | |
| Home Phone | |
| Work Phone | |
| Occupation | |
| E-Mail Address | |
| Are you over 18? | |
| 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? | |
| 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. | |
| Date | |
| |
