| Date: |
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| Which dog(s) are you interested in?: |
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| Fee $: |
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| Full Name: |
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| Address: |
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| Home Phone Number: |
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| Work Phone Number: |
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| Cell Phone Number: |
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| Email Address: |
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| Occupation: |
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| How did you hear about us?: |
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| Why are you looking to adopt from us?: |
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Do you have any or have you owned
any pets in the last 10 years? Y/N: |
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If so, please list Type, Breed,
Length of Ownership and Age: |
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Do you neuter/spay your pets?
If not, why?: |
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How were your current pet(s) acquired?
(adopted/purchased/other): |
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If your pet(s) are no longer with you
please explain the reason: |
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Have you ever given up a pet? Y/N
and any details: |
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If the adopted dog is not altered prior to
adoption, do you agree to have the dog
spayed/neutered within 30 days of adoption?: |
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Please list the name and telephone number of
your current vet (if applicable): |
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Please list the name and telephone number of
your current employer: |
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| Length of time employed: |
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| Your spouse/living partner's name & profession: |
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Please provide two references we may contact
(Name, phone number, email address, years known): |
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Living Arrangements: Do you currently
Rent, Own, or Other?: |
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If renting, we must verify that you are
allowed to have a pet. Is this ok?: |
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| Landlord's Name and Phone Number (if renting): |
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| Do you have a fenced-in yard?: |
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| Does anyone in your home have allergies?: |
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Please list the names and ages of those
living in your home: |
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| How many hours per day will the dog be left alone?: |
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If the dog is left more than 5 hrs, will you
hire a dog walker? If no, why?: |
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| Will he/she be an outdoor or indoor dog?: |
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| Where will he/she be kept when no one is home?: |
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| Where will he/she spend their nights?: |
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Are you aware that the annual cost of veterinary
expenses for a dog are approximately $500?: |
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Are you aware of State & Local Ordinances
concerning leashing?: |
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Are you aware of State & Local Ordinances
concerning licensing?: |
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I understand that this is a life-time
commitment and promise that this decision
was not taken lightly. I understand the
commitment in adopting a dog and am ready
for this step in my life. I have approval from
my landlord (if applicable) and am ready
to adopt this dog with no hesitation.
I have thought about my schedule and
lifestyle and have determined that it is fit
for adopting a dog (please sign): |
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I understand that this application does not
ensure adoption and that I may or may not
be eligible for adoption under the Rescue
Angel's guidelines. I give Rescue Angels
permission to contact my references,
veterinarian, and landlord (if applicable)
regarding all statements in this application.
Misrepresentation or omission of facts is
cause for denial of adoption. By signing
below I attest that all statements made
by me in this application are truthful.
I agree to be bound by all terms of the
Adoption Agreement in the event that
this application is approved by
Rescue Angels (please sign and date): |
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| City and State this application was submitted: |
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