First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Work Phone
x

Cell Phone*

Which animal are you interested in
Choose an animal: Amelia Bobby Bruiser Cash Cooper Stormee

You must be at least 25 years old to adopt an animal. Do you meet these requirements?*

How old are you?*

List two references and phone numbers (who are not family members and do not live with you *NOTE* application can not be processed without phone numbers)*

Co-Applicant Name (if available)

Co-Applicant Age (if applicable)

Co-Applicant Phone Number (if applicable)

Are you currently employed?

If you are not currently employed, please explain why*

If you are employed, how long have you been with your current employer? (please put N/A if you are not employed)*

If you are currently employed, may we contact your current employer for a reference? If so, please list a name and phone number. (if you are not employed please type N/A)*

Who in the household will care for the pet*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Lease Own Rent

How long have you lived at your current residence?*

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

Does your landlord, homeowner's association, county/township/municipality have any restrictions?*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Kennel or Dog Run in Yard Yard Partially Fenced Yard Completely Fenced

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

How many people reside in your household*

Out of the number of residents in your household, how many are adults?*

Please list the names and ages of all adults in your home*

Out of the number of residents in your household, how many are children?

If you have children, have they been around animals and pets before?
Choose one: Yes No

Ages of children, if any?

Does anyone in your house currently have allergies to pets or have asthma?*
Choose one: Yes No

Who will care for your pet when you go away on vacation?*

In the unfortunate event you pass away or are no longer able to care for the pet, do you have arrangements for your pet(s) continued care? If so, please explain.*

Why are you interested in adopting a pet at this time*

Veterinarian's Name and Phone Number. If this is your first pet, please provide who you will use going forward.*

List any pets you currently own, or have owned, in the past ten years, as well as their ages.*

Where are these animals now?*

Are/Were all of these pets spayed/neutered?*
Choose one: Yes No

Are/Were all of your pets up to date on vaccinations?*
Choose one: Yes No

Are you aware of and do you use heartworm preventive?*
Choose one: Yes No

Have you applied with any other rescue*
Choose one: Yes No

Have you ever adopted from an animal welfare group before? For example, Humane Society, another Rescue organization, etc.*
Choose one: Yes No

If yes to above, please state which group.

Have you ever given up a pet? If yes, please explain*

What traits are you looking for in a pet

Are you aware of crate training?*
Choose one: Yes No

Have you ever housebroken an animal before?*
Choose one: Yes No

In the event your pet has an accident in your home, what type of corrective action do you plan to use?*

How much time will the animal spend alone during the day*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal sleep*

Where will the animal be kept when you are home*

Where will the animal be kept when you are not home*

Describe how you will train the pet*

What length of time are you willing to allow your new pet to adjust to his/her new home and your rules?*

A new environment/home is stressful to your new pet and they may exhibit uncharacteristic behavior. Are you willing to work through your new pet's issues, if any?*
Choose one: Yes No

Do you understand that your new pet could be, up to, an 18 year commitment and cost upwards of $300 or more per year to care for?*
Choose one: Yes No

Most of our animals for adoption have undergone temperament evaluations and have lived with foster families prior to their adoption. While in foster care, we begin training and work to resolve any known behavioral obstacles before adoption. Generally, we are only able to give you the dog's history from the time he/she enters our program. Are you able and willing to continue working on these challenges to ensure that your adopted animal is a respectable companion?*
Choose one: Yes No

Do you agree to only use positive reinforcement methods of training as opposed to physical methods (i.e., hitting, punching, kicking)?*
Choose one: Yes No

Are you aware that some large breed animals take about 2 to 3 years to fully mature? Is this something that you are prepared for?*
Choose one: Yes No

What circumstances would lead you to give up your newly adopted animal? Please explain.*

In the event you had to surrender your animal, what would you do with him/her?*

Caring for animals is costly when it comes to necessary or critical vet care, feeding, spay/neuter, microchipping, transporting, training and foster care. Our adoption fees cover these costs and can range from $150 to $500. Do you agree to pay the adoption fee associated with this/these animal(s)?*
Choose one: Yes No

I certify that the information entered on this applicant is true. Enter your name and date*

How did you hear about us*

Is there anything else you think we should know?