Applicant's Personal Information
Applicant's Full Name:
Applicant's Age:
Spouse's Full Name:
Spouse's Age:
Applicant's Address:
City:
State:
Zip Code:
Applicant's Phone Number (Include area code):
Applicant's Email Address:
Are you planning to change your residential situation in the near future?
If YES, please specify details:
Applicant's Employer:
Spouse's Employer:
IF EVERY QUESTION IS NOT ANSWERED, YOUR APPLICATION WILL NOT BE REVIEWED!
If you do not have one, list the veterinarian you have used in the past or plan to use in the future.
Veterinarian's Full Name:
Veterinarian's Full Address
City:
State:
Zip Code:
Veterinarian's Phone Number (Include area code):
What type and how many pets do you have?
Is the pet your applying for going to be a gift?
If YES, Does the recipient know they are receiving this gift? Explain:
If NO, Why do you want to bring a new pet into your home?
Is everyone in your household in agreement to adopt a new pet?
If NO, please specify the reasons:
Please indicate the name of the pet you are interested in adopting:
Have you had any pets in the past?
If yes, what types of pets? Please specify breed.
Were your prior pets spayed or neutered?
If NO, please explain:
How many years did you own said pets?
Reasons for no longer owning/deaths of said pets?
Have you ever lost any of your pets?
If YES, please explain:
Have any of your pets ever been poisoned?
If YES, explain:
Have any of your pets ever been killed by a vehicle?
If YES, explain:
Do you have children under the age of 10 living in your home or that visit?
If YES, please specify the number of children and their ages (please include if they live at the residence or visit):
Please List ALL adults/ages/relation to adopter who are living to your house
IF EVERY QUESTION IS NOT ANSWERED, YOUR APPLICATION WILL NOT BE REVIEWED!
What is your primary place of residence?
Do you Own or Rent?
Do you have a yard?
Is your yard completely fenced in?
If fenced, what kind of fence (chain link, privacy, etc) and how tall is it?
How large is the fenced in area?
Would you need to leave your pet unattended in the yard while no one responsible is home?
Explain:
Where will you keep your pet?
Please explain:
What provisions will be made for your pet when no one is home during the day? Explain.
In the evening/night time? Explain.
When you go on vacation? Explain.
How long have you been looking for a pet?
Where have you looked for a pet prior to contacting us?
Do any members of your household fear animals?
If yes, please explain:
Is anyone in your household allergic to animals?
If yes, please explain:
Who will assume ALL financial responsibility for your pet's vaccines, veterinary care, quality food, and licensing?
Are you familiar with the animal laws and regulations in your area?
If you have any behavioral issues with your pet, will you seek professional training assistance and are you committed to working through any issues with this pet?
Please explain:
If there is anything else you would like
us to know about you, please do so here:
IF EVERY QUESTION IS NOT ANSWERED, YOUR APPLICATION WILL NOT BE REVIEWED!
Personal References (required))
Provide two personal references (not family) that are pet owners. (neighbors, friends, etc)
Name:
Relationship to applicant:
Phone Number:
Name:
Relationship to applicant:
Phone Number:
By clicking "Send" and submitting this application for adoption, you certify that you are 18 years of age or older, understand the contractual obligations set above, and the information you have provided is true and accurate. You give Companion Animal Rescue & Education permission to contact any and all references listed above.
I understand and agree that falsification of any information given is grounds to disqualify my adoption application and nullify any
adoptions and/or adoption agreements between the applicant/family and Companion Animal Rescue & Education. I understand that Companion Animal Rescue & Education has the right to refuse any adoption.
