Thank You, 

for choosing to save the life of a rescue animal !

                            * = REQUIRED FIELD

                            Just complete this form. Click "SUBMIT" once when done.

Rescue pets name:

* Your name (first - last):
* Email address:

* Address:

Apt #:
* City:

* State:

* Zip:

* Home phone: xxx-xxx-xxxx

* Day Phone: xxx-xxx-xxxx

* Place of employment:

* Driver lic # or Social sec #:

* What kind of pet do you wish to adopt?

click here to select Dog - adult Dog - puppy

* Do you have preferences as to Breed, Age, Sex, Size, Length of hair...

* Why do you want a pet?

* Is this your first pet? click here to select yes no

If NO tell us about the pets do you currently have in your household?

( Name - Species - Gender - Spayed / Neutered - Indoor / Outdoor - Age - Current on vaccines )

Tell us about pets you have owned in the last five years that are no longer with you.

( Name - Species - Gender - Spayed / Neutered - Indoor / Outdoor - Age - Why they are no longer with you. )

* Who is your vet? 

* Do you plan to take your new pet to your vet soon after the adoption? 

click here to select yes no

* You live in a...

click here to select House - Own House - Rent Apt/Condo - Own Apt/Condo - Rent Mobile Home - Own Mobile Home - Rent Dueplex

* If you rent does you lease allow pets? 

Click here to select yes no

* Landlord contact information ( Name -Mgnt Co. - Phone )

* How long have you lived at address above?

 years / months  

* How many people live in your household? 

click to select adults 0 1 2 3 4 5 6 7 8 or more click to select children 0 1 2 3 4 5 6 7 8 or more

What ages of the children in your household?

* Do all adults know you plan to adopt a pet?

Click here to select yes no

* Dose anyone in your household have allergies to animals?

click here to select yes no

* Who will be primarily responsible for the care of this pet? 

* Please describe where your pet will be kept during the day.

* Please describe where your pet will be kept during the night.

* How many hours of the day will the animal be left alone? 

click to select hours 1-2 3-4 5-6 7-8 8-10 10 or more

* Where will it be left alone? 

* Do you understand why rescue pets are spayed or neutered? 

click here to select yes no

* How did you hear about our rescue program? 

* How much money do you plan to spend on your new pet in the next two months? 

amount $0 - $50 $50 - $100 $100 - $150 $150 - $200 over $200

* Do you feel financially secure to provide your pet with basic medical care and to 

provide necessary medical treatment in the event of an emergency? 

click here to select yes no

* Are you familiar with micro chipping? 

click here to select yes no

* Are you familiar with leash and licensing laws in you community? 

click here to select yes no

* What arrangements will be made for the animal when you travel? 

Are you a member of any dog clubs or organizations? 

click here to select yes no

* Do you have any concerns regarding this animal such as 

( Size, Temperament, Hair, Obedience, Energy Level, Housebreaking, etc... )

* What do you want a dog for? check all that apply.

House pet           Watch dog        Guard dog    

Companion     Gift     company for other pet  

* Do you have a fenced yard?

click here to select yes no

if YES, how high?

click here to select 3 ft 4 ft 6 ft 8 ft 10 ft

* Do you plan to housetrain your new puppy or dog?

click here to select yes no

Are you interested in info on housetraining?

click here to select yes no

* What will you do if your dog chews or shows destructive behavior?

* Are you familiar with crate training? 

click here to select yes no

* What are your feelings about it? 

* Do you plan on teaching you puppy or dog basic obedience? 

click here to select yes no

* Are you familiar with heartworm disease? 

click here to select yes no

* Are you aware that heartworm disease is common in dogs and cats? 

click here to select yes no

* Are you familiar with tapeworms and the importance of flea control? 

click here to select yes no

* How long do you believe your dog will need to be on heartworm prevention?

click here to select 6 mo 1 yr 2 yrs 3 yrs lifetime

* What is your level of commitment to this animal?

Please select one of the following:

    I understand that training my animal may take many months and I am willing to do whatever it takes. I am financially able to        pursue additional training methods if needed.  I further understand that my rescue animal needs a permanent lifelong home and the movement from one home to another can be debilitating to an animal's mental and physical well being.  I am emotionally and financially committed to this animal.

    I am not completely sure what the future may hold and this may have an impact on my animal.

    I am dedicated at heart but I am not sure if I can emotionally and/or financially deal with any behavioral and/or physical problems that may occur

Other

 

Our shelter is caring for these animals because they were abandoned and we are, therefore cautious when reviewing potential new homes. 

Note - We are an all volunteer organization, please be patient with us...

   Thank You,  for taking the time to fill out our adoption application.

Please allow 24 - 48 hours for processing and review.