Pet Adoption Application

You must be at least 18 years of age to apply.

I want to adopt a: *
Dog Name *
Cat Name *
Today's Date *
Applicant's First Name *
Applicant's Last Name *
Contact Number *
Email Address *
Street Address (incl apt # if applicable) *
City *
State *
Zip Code *
I certify that I am at least 18 years of age. *
How did you hear about us? *
Do ALL adults and other members in your household agree to this adoption? *
Household members consist of (can select multiple): *
I am looking to adopt for the following reason(s): *
What is your level of pet care experience? *
My adopted animal will live: *
Have you adopted or currently applying to adopt from another rescue group/shelter?:
Are you Currently Employed? *
Occupation/Employer *
Weekly Hours Worked *
Do you currently or have you in the past owned pets? *
If you have current pets, are they neutered or spayed? *
Please list your current animals including age: *
What happened to the animal? (Select multiple if applicable) *
We ask that you provide us with a personal reference so that we can get some feedback about you as an individual. May we contact your personal reference? *
Personal Reference Name *
Personal reference's Phone Number *
How do you know your personal reference? *
What type of residence do you live in? *
Do you Rent, Own or Live with someone else? *
Do you live in an HOA? * Some HOA's do not allow certain breeds of dogs, and you should always check that the rules of your HOA allow the breed of dog that you are looking to adopt.
*	If you live in an HOA, you should be aware that some HOAs do not allow certain breeds of dogs. Please, always be sure you check the rules of your HOA before applying to adopt a dog to ensure that the specific breed is allowed. Please check this box to show you understand.
Do you have a way to contain the dog safely? *
Please describe area that the dog will be contained (inside and outside). *
Please list Landlord's Name/Company (we will call to verify that animals are allowed on property) *
Landlord's Phone Number *
Are you moving soon? *
If you are moving soon, what is the plan for your new pet? *
If you are planning to move, where are you moving to? *
What is your general philosophy on vet care? *
Do you currently have a veterinarian? *
Current vet clinic name and address *
Current veterinarian's phone number: *
Will you keep your dog on heartworm preventative? *
Will you have your cat declawed? *
Will the dog ever be left alone? *
How many hours (daily) will your dog be left alone? *
When your dog is left alone, where will he/she be left? *
How will you housetrain your dog? (Select multiple if applicable) *
If other, please explain *
How will you discipline if your new pet chews on household items? (Select multiple if applicable) *
How will your new pet get exercise? *
Please list any reason you may have to give up an adopted animal. *
In the event that you cannot keep your pet, for any reason, do you agree to contact Shelter2Rescue prior to any action taken? *
*	Shelter2Rescue Coalition and the representatives of the rescue reserve the right to call and verify care of the adopted pet with the veterinarian. Please check to signify you understand this.
I hereby agree to hold Shelter2Rescue Coalition, Inc and it's representatives harmless against any and all claims, damages, cost, expenses, or other items pertaining to the pet that is being adopted, or anything resulting from or caused by the adopted animal. *
I would like to opt- in to receive occasional updates, donation information, etc from Shelter2Rescue (I can opt out later via an email request) *
Full name (typed name will be accepted as signature) * Typed name will constitute a signature
*	We apologize, but we are unable to assist you with an adoption at this time due to the fact that you are under 18 years of age. Please check here to note that you agree.