Todays Date
Pet's name and Id number
1)Name / Applicant
Phone
Phone
2) Name /Co-Applicant
3) Physical  Address
City
Zip Code
State
4) e-mail address
5) Type of residence
6) If renting or living with parents, do you have permission to house a pet?  
phone
7)/Parents Landlord's Name
Work phone
8) Your Occupation
Employer
phone
9)Checkable (vet) Refs
10) Personal references
phone
11) Personal references
phone
If so how many
12) Is there a dog limit in your city/town?
13) Why do you and your family want a pet?
14) Why have you chosen this particular pet
16) What age do you prefer?
15) preferred Breed
17) What size pet when full grown,do you prefer?
18) What gender do you prefer your pet to be?
19) Where will the pet be housed?
20 )How will your pet get exercised
21)Hours away from
pet during the day
explanation
22) Where will  pet be
kept while at work?
explaination
23) Name and age of all adults in household:
24) Name, age and sex of each child
yes
 No
25) Any pet allergies in your family
26) Does everyone in your family agree to adopting this pet?
 No
yes
27) If no, who isn't and why
All pets that ended in our rescue/shelter or foster homes have been rejected for one
reason or another. Foster homes will need to rehabilitate them working on everyday
basics such as housebreaking leash training and crate training.  Most of their efforts
are concentrated on re- gaining the pets trust in people. Depending on each dog and
his/her  treatment in prior homes there may be other issues to deal with too,. Yet
some pets require no work at all. As with any new pet you may bring into your home,
they all need a period of adjustment. When going from the streets, to a foster home,
and again being re-homed to a permanent home they may regress a little and each
pet is different. Our representative will be there to help you and your new pet's
adjustment period go as smoothly as possible. With all this in mind please answer
the following questions to the best of your ability.
28) Have you or any member of your family ever been
charged with animal neglect, abuse or agrivated abuse?
29) Have you ever adopted a pet from a rescue/shelter before?
30) If yes, please list the rescues/shelter and
their contact person and phone numbers.
31) How long of an adjustment period do
you think a pet should be given and why?
32) Is your entire family willing to work with your  
new pet on any issues that he/she may have?
33)  What dog behaviors would be
unacceptable to your family?
34) Are you and your family aware that if you foster or adopt a pet
from our rescue, you are required to return the pet to us at your own
expense if you can no longer keep the it?
35) Are you aware, if you foster or adopt from our rescue / shelter you
may not adopt it out to anyone without following our adoption
procedures or you will be responsible for the recovery of the pet and all
reasonable court costs?
36) Are you aware that if you adopt a pet from our rescue/shelter and
we learn you are not meeting with our standards on caring for the pet
that you are required to return the pet to us immediately and at your
own expense
37) If you are the sole adopter, have you considered
making arrangements for this pet in the event of your
illness or death? If so What will they be?
List  other animals currently living in or around your home.
38) Type of pet
 Breed
 Gender
age
How long have you owned this pet?
 
39) Type of pet
Gender
Breed
age
How long have you owned this pet?  
40)Type of pet
Breed
Gender
age
How long have you owned this pet?  
41)Type of pet
Breed
 Gender
age
 How long have you owned this pet?
 
42)Type of pet
Breed
 Gender