Applicant's Full Name:
Applicant's Home Address (include Street, City, State and Zip):
How Long Have You Lived at This Address?:
Applicant's Home Phone Number:
Applicant's Date of Birth (optional):
Spouse's Name:
Best Time to Call:
Applicant's Email Address:
Name of Applicant's Current Veterinarian: *(if you do not currently have a pet/veterinarian, then list the name of the vet you previously used)
*Veterinarian's Address:
*Veterinarian's Phone Number:
Have you given your veterinarian your permission to speak with us and provide information about your pets?
1. Why do you want to bring a new pet into your home?
1A. Is everyone in your household in agreement on adopting a pet?
2. Is there a pet on our web site that you are interested in? If so, please specify.
3. Have you had pets in the past? (Yes or No)
4. If you answered Yes to Question 3, then please answer questions 4A. through 4C. below.
4A. What type of pet(s) did you have in the past?
4B. How many years did you own the pet(s)?
4C. Reason for no longer owning the pet(s)?
5. Do you have any pet(s) currently? List names, type, breed, age, & sex.
6. Has any pet of yours ever gotten lost? If yes, please provide explanation.
7. Has any pet of yours ever been poisoned? If yes, please provide explanation.
8. Has any pet of yours ever been killed by a vehicle? If yes, please provide explanation.
9. Would you allow a dog to ride loose in the bed of a truck?
10. What were the circumstances of your last pet's death?
11. Would you leave a pet unattended in the yard?
12. Do you have any other animals? List type, age, gender, and quantity.
12A. Are your current pets spayed/neutered? If not, please explain.
13. Do you have children at home? If so, specify number and ages.(Reminder : All Pets Rescue does not place dogs in homes with children under the age of 6.)
14. Do you live in a house, apartment, condominium, or trailer?
15. Do you rent, or own?
NOTE :
If you rent, you MUST have written permission from your landlord stating that
you are allowed to keep a pet in the apartment.16. Do you have a yard and is it completely fenced in?
17. If your yard is fenced, what type of fencing do you have, and how tall is it? (Check all boxes that apply and Be Sure to Specify Height.)
17A. Do you have a swimming pool in your yard?
17B. If you have a swimming pool, is it totally enclosed by fencing?
17C. If you have a swimming pool, and it's totally enclosed by fencing, what kind of fencing is it?
18. What provisions will be made for your pet when no one is home during the day?
18A. What provisions will be made for your pet when no one is home during the evening?
18B. What provisions will be made for your pet when you go on vacation?
18C. How many hours will the pet be left alone each day (or evening)?
19. Where will you keep this pet? Please specify details?
20. Specify if you have a gender and breed preference for the pet you want to adopt.
21. Specify if you have a color preference for the pet you want to adopt.
22. Would you be willing to expand on your gender, breed, and color preferences?
23. How long have you been looking for a pet?
24. Where have you looked for a pet prior to contacting All Pets Rescue?
25. Do any members of your household fear animals? Please specify details.
26. If you answered yes to Question 25, how will you manage the transition of a new pet into your home?
27. Will you assume all financial responsibilities for the pet you adopt, including inoculations, veterinary care, good quality food, licensing, etc.?
28. Are you planning to change residence in the near future? Please specify details.
29. Is anyone in your home allergic to animals? Please specify details.
30. Are you familiar with the animal laws and regulations in your area?
31. Is the pet for which you are applying going to be a gift?
32. If you answered yes to Question 31., does the recipient know they are getting this gift?
33. Do you understand that pets you adopt from All Pets Rescue will be spayed/neutered?
34. If All Pets Rescue recommends that you take obedience or agility training classes with your pet, will you do so?
Please provide names and contact information for two references (neighbors, relatives, friends) that have been to your home.
Reference #1: Name of Reference #1:
Relationship of Reference #1 to Applicant:
Address of Reference #1:
Home/Evening Phone Number of Reference #1:
E-Mail Address of Reference #1:
Reference #2: Name of Reference #2:
Relationship of Reference #2 to Applicant:
Address of Reference #2:
Home/Evening Phone Number of Reference #2:
E-Mail Address of Reference #2:
By signing below, I certify that I have read, understood, agree with, and will comply with, the ALL PETS RESCUE
ADOPTION POLICY . (Yes or No):
By signing below, I further certify that the information I have provided on this form is true, correct, and accurate. (Yes or No):
I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the applicant and All Pets Rescue. (Yes or No):
Signature:
Date:
