Animal Education & Rescue

Your E-mail Address

Pet you are interested in (name/breed - or - type)

Your Full Name (first & last)

Age

Daytime Phone #

Evening Phone #

Best Time to Call

Home Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Employer Name

Contact Person

Employer's Phone #

Length of Employment

Work Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Applicant #2's Full Name

Age

Daytime Phone #

Evening Phone #

Best Time to Call

Who is the legal homeowner?

Employer Name

Contact Person

Employer's Phone #

Length of Employment

Work Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Name

Age

Relationship

Full/Part Time Select... Full Time Part Time

Select... Full Time Part Time

Select... Full Time Part Time

Select... Full Time Part Time

Is any family member allergic to pets? No Yes...     If yes, how is it treated?

Name

Relationship

Phone #

E-mail

Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Name

Relationship

Phone #

E-mail

Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Vet's Name

Clinic

Phone #

Address

City

State Select... AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Zip

Name

Breed

Age

Years w/ You

Where are they kept?

Gender ... Male Female

Fixed ... Yes No ?

... Male Female

... Yes No ?

... Male Female

... Yes No ?

... Male Female

... Yes No ?

Name

Breed

Age

Years w/ You

Reason not with you

Gender ... Male Female

Fixed ... Yes No ?

... Male Female

... Yes No ?

... Male Female

... Yes No ?

... Male Female

... Yes No ?

Have you ever applied to adopt from a humane society or rescue group? If so, which one(s)? Was it successful (if not, explain why)?

Have you ever surrendered an animal to a humane society, shelter, rescue group or other party? If so, why?

Have you ever had any complaints about your pets?

Type of Residence Select... Single Family Home Townhouse / Condo Apartment

Own or Rent? Select... Own Rent

If renting, provide landlord's name and phone #

How many hours a day will the pet be left unattended and where will they be?

Where will the pet be kept during the day?

At night?

Who will care for the pet when you travel?

What other breeds have you considered? Why?

Who is this pet for?

Who will have primary responsibility for food, training, cleanup and Veterinary care?

Have you discussed the pro's and con's of pet ownership with you family? Y N

Does everyone in the house want a pet? Y N

How much are you expecting/willing to spend on your pet each year (including vaccinations, food, grooming and vet care)?

Are you willing to be responsible for the entire lifespan of your pet (could be 15+ years)? Y N

How will you discipline your pet?

Will you accept your pet may exhibit behaviors such as aggression, scratching, litterbox issues, etc.? Y N

How will you handle these behaviors

Please use the box below for any additional comments or questions you may have