Pet Adoption Application v2

Today's Date *

I want to adopt a: *

Adoptable Animal Name *

Applicant's First Name *

Applicant's Last Name *

Contact Number *

Email Address *

Street Address (incl apt # if applicable) *

City *

State *

Zip Code *

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?:

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) *

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 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? *

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?

I may have to give up my pet if (Select multiple if applicable)? *

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? *

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) *