K-9 Rescue Adoption Application

Name of Dog Applied for:

Where did you first see this Adoptable:

Applicant Name:

Date of Birth:

Email Address:

Cell Phone:

Legal Address (Street Address)

City

State

Zip

Rent/Own:

Type of Home:

How long at this address?

Landlord Name

Street Address

State

Zip

Landlord Phone Number:

Is your landlord aware of your interest in adopting a pet?

Yes No

Any breed stipulations, deposit requirements (be specific)?

What happens to the pet if you move?

Previous Address

Rent or Own

How Long At?

Primary Social Media Page and Source:

List all residents of this address including current pet:

Name

Age

Relationship or Type of Pet

Male or Female

Are Pets vaccinated and spay or neutered?

Yes No

Do pets have a microchip?

Yes No

Current Veterinarian’s Name

Previous Veterinarian’s Name

Current Veterinarian’s Phone:

Previous Veterinarian’s Phone:

Personal Reference #1: Name

Personal Reference #2: Name

Personal Reference #3: Name

Personal Reference #1 Phone:

Personal Reference #2 Phone:

Personal Reference #3 Phone:

Employer

Employer Phone:

Length of Time with Current Employer:

Any pets in the past?

How will pet be exercised?

Average time away from home daily?

Where is pet now?

Where will pet be kept when away from home?

Where will pet sleep at night?

If they did not cross the rainbow bridge due to age or sickness, why are you no longer responsible for them?

If due to sickness please explain?

Does the home where pet resides have a fenced in yard?

Yes No

Does anyone who lives in home have allergies?

Yes No

Does anyone in the home require medical equipment that may startle a new pet?

Yes No

Have you or anyone in your household ever been convicted of animal cruelty, neglect, or abandonment?

Do you believe a dog should receive lifetime training?

Yes No

How do you plan to train your pet?

Please explain why you would like to adopt the pet you are applying for.

If for any reason we do not determine this pet is a good fit, are you interested in us suggesting another that may be a better suited to your lifestyle?

Yes No

Date