Independent Pet Rescue and Adoptions

Pet Adoption and/or Waiting List Application

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Please complete the following information and submit to us. After we review your application, we will respond to you at the contact information you have provided. With your submission of this application, you are under NO obligation to adopt one of our pets.

Thanks for considering us for a pet adoption.

Note: The entire application must be completed, for our review, in order to complete an adoption. With the effort and costs put into our rescues, we want to insure that our pets will have, both a good adoption, and also that the adopter will be completely satisfied and matched with the pet they are adopting. If wanting to be put onto our waiting list, providing a fully completed application, allows us to "pre-approve" you, for an eventual quicker adoption process.

"The Greatness of a nation and it's moral progress can be judged by the way it's animals are treated." Mahatma Gandni (1869-1948)

To help us provide better adoption services,
please advise how you found us: Please Select Below Search Engine (Please Enter which one below) PetFinder.com Referral from Another Site (Please Enter which one below) Poster (Please Enter Location, below) Other (Please explain below)

How you found us (Additional Explanation)...Thanks,
.

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The section below must be completely entered in order for us to be able to contact you
and insure that you are at an appropriate location for us to adopt.

Applicant's Name:

Home Phone: Cell Phone:

Street Address: City:

State/Zip: Email Address (Required):



Employer: Employer Address:

Hours Worked (Per Day): Hours Worked (Per Week):



Pet Name Applying for:

Pet Type Applying for:

Pet Breed Applying for:



Current Pets Owned (Number of Dogs, Cats, Other):

Previously Owned Pets:



Your Veterinarian:

Veterinarian Address:

Veterinarian Phone:



Personal Reference (Name):

Personal Reference (Address):

Personal Reference (Phone):



Reason For Adoption (Select One): Select One Below Companion Guard Breeding Gift Other If Other (Explain):



Children at Home (Number/Ages):

Who is Responsible for Pet:

Where Will Pet be Kept: Select One Below Inside Outside Both

Do You Have a Yard: Select One Below Yes No If Fenced, Type & Height:

Will dog be chained in yard? Select One Below Yes No

If you have to move, what will you do with this pet:



Residence Type: Select One Below House Apartment Other If Other (Explain):

Do You Own Residence: Select One Below Yes No If not, Does Landlord allow pets:



Do you agree to provide all necessary medical care including a rabies vaccination and heartworm/flea tick preventative meds? Select One Below Yes No

If Pet is Not Spayed/Neutered, do you agree to have this done? Select One Below Yes No

Do you agree to obtain a license for your pet, to be renewed annually? Select One Below Yes No

Are you aware of how difficult it is to locate housing that will accept pets?: Select One Below Yes No

Will you have sufficient time for training, exerecising, grooming and playing with your new pet?: Select One Below Yes No

Any additional comments or Information you would like to add?: .

We would like to thank you for applying to adopt one of our pets. Please note that as we generally receive multiple applications for our pets, we must make a selection for the best fit for both the pet and the adopter. If we have multiple applications where the fit is good for both, we then select on a first come first served basis.

If by chance, you are not selected to adopt this pet, we can add you to our waiting list, by your providing a description on what you are looking for below. If we rescue a pet that fits your description, we will contact you to see if you are interested or not. Remember that you are under no obligation to adopt any pet that we contact you on.

Would you be interested in being added to our waiting List? Yes, (Provide Description below) No Thank You

For Our Waiting List, provide information for the pet you are looking for (dog, cat, breed, weight, temperament etc.)
.



As a Signature, Please enter your name:

Date Signed:

"We Reserve the Right to Refuse any Adoption!

Please complete my
Pet Adoption Request Form or email me
if you would like more information or have questions on any of our pet procedures.

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