Adoption Application

Which pet are you interested in adopting? *

Your first name *

Your last name *

Your Email *

Your cell phone number *

Your date of birth

What is your profession and employer?

Do you presently reside with any other co-applicants, which are adults that have a role in household decision making?

Co-applicants date of birth

Co-applicant's phone

Co-applicant's Email

Co-applicant's place of employment

Address *

City *

State *

Zip Code *

What type of home do you reside in?

House
Apartment or Condo
Mobile Home
Other

Do you rent or own?

How long have you lived at this current address?

How many times have you moved in the past 5 years?

What would you do if you moved to a residence where pets are not permitted?

Do you have a fenced in yard?

Are you willing to provide photos of your home?

How many adults live in this household?

How many children and ages, live in this household?

Is EVERYONE in the household in agreement to adding a new pet to the family?

Is this your first pet?

Current & Previous Pet Information Please tell us about all pets that are currently living in your home? (N/A if you have no current pets)

Are all current pets up to date on vaccinations?

Are all current pets spayed and/or neutered?

If any are not spayed or neutered, please explain why

Have you ever given a pet away, given it to a shelter or rescue group, returned it to a breeder or sold it?

Have you ever had a pet for a short period of time and it didn't work out?

If you have had a pet and it didn't work out, please explain?

Have you ever had an animal lost or stolen?

Have you ever had to retrieve your animal from a pound, shelter or animal control?

Tell us why you wish to add a new pet to your family?

What activities you plan to do with your new pet?

What provisions will be made for your pet when you go on vacation?

What provisions will be made for your pet if alone

Under what circumstances have you ever or would you ever give up your pet?

Please provide your vet's contact information

Please provide a reference that is not related to you, (phone & email) *

Provide a second reference that is not related to you (phone & email) *

Provide a third contact (can be related) *

Do you agree to provide an adoption fee to help cover our costs of spay/neuter, all shots, microchip and transport, and other related expenses? The fee can range from $250 to $500 depending on age and circumstances.

Do you agree to provide KC Pet Rescue with occasional updates and/or photos of your pet in the future?

Any thing else you would like to add?

I certify that the information I have provided on this form is true, correct, and accurate. *

I certify that I am financially and physically able to care for the animal that I adopt. *

I understand and agree that falsification of any of the above information is grounds to disqualify and/or nullify this application. *

I understand that KC Pet Rescue is under no obligation to place an animal with me, now or in the future.

I hereby understand and agree that my new pet will NOT be immediately introduced to existing pets in the home upon arrival. I understand that my new pet will need ample time for decompression and KC Pet Rescue can provide literature on proper methods and time periods for decompression as well as how to properly introduce a new pet to existing pets so there will not be any conflicts. *

I hereby understand and agree that should there be any extenuating circumstances where I am unable to keep the new pet, I will immediately contact KC Pet Rescue for further instruction and I hereby agree to allow UP TO THREE WEEKS for KC Pet Rescue to retrieve the animal, during which time I understand I may need to keep the animal separated from existing pets and or children in the home if any conflicts have arisen. Under NO circumstances will I rehome the pet, drop the pet off at a shelter or with animal control, or tie or release the pet outdoors. *

I understand that my electronically-provided signature [below] is valid as a means of legal signature for the purpose of this foster/adopt application and that a background check may be performed. *

Type full name to electronically sign *