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Adoption Application
Name of the pet you are applying for
How did you hear about us?
Your Name
Phone Number
Cell Phone Number
Your Address
Employer
E-Mail Address
Why do you want to adopt?
Please list preferences you would like.
Have you submitted an application to another rescue before?
Yes
No
If so, with who?
Have you been declined for adoption?
Yes
No
If so, please explain.
Are you willing to house break a puppy/dog?
No
Yes
Would you ever return/give up your pet?
Yes
No
If so, please explain.
How many people live in your home?
Are there any children?
No
Yes
If so, please list ages.
Who will be the primary caretaker of dog/puppy?
Please describe pets already owned?
Are your pets spayed/neutered?
Yes
No
If not, please explain.
Where will your pet sleep at night?
Where will your pet be during the day?
How long will your pet be alone during the day?
Do you agree to monthly heartworm/flea treatment?
Yes
No
If not, please explain.
Who is your vet/animal hospital?
Address
Phone Number.
Do you own your own home?
Yes
No - Rent
If not, please list landlord name and number.
Do you have a fenced yard?
No
Yes
If not, how will pet be contained while outside?
Would you object to sending updates of your adopted pet to our group?
Comments
You certify that you are over 21 years of age.
No
Yes - I Am 21 Yeas of Age or Older
Your online signature (please type your name)
Yes, please add me to your email list!
Yes
No
Do not fill this textbox.
Please note that completing this application does NOT guarantee you will be approved.