Adoption Application - Animal Education & Rescue

Please select the type of animal you are submitting for this application*

Dog
Cat
Small Animal

Name of dog(s), type, breed, or age you are interested in

Name of cat(s), type or age you are interested in

Name of animal(s), you are interested in

Email*

Applicant #1*

Full Name (First & Last)	Age	Daytime Phone #	Evening Phone #	Best Time to Call

Address*

Street Address Address Line 2 City State ZIP Code

Employer Name	Length of Employment	City	State

Applicant #2 (2nd Adult in the household ... if applicable)

Full Name (First & Last)	Age	Daytime Phone #	Evening Phone #	Best Time to Call

Employer Name	Length of Employment	City	State

Additional Family Members

Who is the legal homeowner?*

List ALL ADDITIONAL family members who reside in your household, whether full or part time

Name	Age	Relationship

Is everyone in the family aware that you are planning to Adopt?*

Yes
No

If no, please explain

Family Pet Allergies

Is any family member allergic to pets?*

Yes
No

How is it treated?

References

Reference #1*

Name	Relationship	Email

Phone #	City	State

Reference #2 (not related to you)*

Name	Relationship	Email

Phone #	City	State

Vet Reference

Animal Hospital/Clinic Name	Phone #	City	State

Pets

Do you currently have any pets?*

Yes
No

Current Pets*

Name	Breed	Age	Years with You	Gender	Spayed/Neutered Y/N

Are your pets current on their vaccinations?*

Yes
No

Pet History - Past 20 yrs.

Name	Breed	Age	Gender	Years with You	Reason not with you

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 a pet? If yes, why?*

Residence

Type of Residence*

Own or Rent*

Landlord's Name and Phone Number

How long have you lived at this address?*

Who will take care of the pet when you travel?*

Is your yard fenced?*

Yes
No

What type of Fence do you have?*

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

Where will the dog be kept during the day?	At night?

Where will you exercise your dog and how often?*

Will the cat be indoor or outdoor cat - please describe?*

General Information

Who is the pet for?*

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

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

How will you discipline or handle the situation if your pet exhibits behaviors such as accidents, barking, chewing, or aggression?*

Do you plan on de-clawing your cat?*

Yes
No

What would you do with your animal if you had to move?*

For what reason(s) would you consider returning/giving up the animal?*

General Comments

How did you hear about us?

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

By checking this box, I am acknowledging that I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal. By checking this box, you also are confirming that you understand that as a volunteer organization we cannot reply to every application that is submitted. There are many reason for this which will be explained in the email you will receive after submitting this application.

Name

This field is for validation purposes and should be left unchanged.