| Pet interested in adopting: |
|
| Last name: |
|
| First Name: |
|
| Email address: |
|
| Phone #1: |
|
| Phone #2: |
|
| Physical address: |
|
| City: |
|
| State, zip: |
|
| How long have you lived at the current address?: |
|
| Type of residence: |
|
| Do you rent or own?: |
|
| If renting, lanlord's name, phone # |
|
| If renting, are pets allowed? |
|
| My yard is: |
|
| Marital status: |
|
| # of adults in household: |
|
| # and ages of children in household: |
|
| Do children visit your home?: |
|
| Ages of children: |
|
| Who will be the responsible caregiver of the new pet?: |
|
| Concerns you or your family may have about adopting a new pet: |
|
| Do any family members have known allergies?: |
|
| If yes, please explain: |
|
| Type of pet you were thinking of adopting: |
|
| How long have you been considering adopting a new pet?: |
|
| Reason for wanting to adopt a new pet: |
|
| What is the pet for?: |
|
| If gift, please explain: |
|
| Your or your spouse's employer: |
|
| Employer phone: |
|
| Employer address: |
|
| # of hours pet will be home without human companionship: |
|
| Where will pet be kept during the day or when home alone?: |
|
| Where will the pet be kept at night?: |
|
| Will the pet be kept outside or inside the majority of the time?: |
|
| What is the maximum length of time the pet will be outside unattended?: |
|
| Please list all current pets (names, breeds, sex and ages): |
|
| Are your pets spay/neutered?: |
|
| Are all your pets current on vaccinations and heartworm preventative (dogs)?: |
|
| What vaccinations or treatments will you keep your new pet current on?: |
|
| What is your estimated annual cost of care for the pet you are thinking of adopting?: |
|
| What would you do if emergency or general medical care exceed $1,000 dollars?: |
|
| What brand of food do you plan to feed your new pet?: |
|
| Veterinary reference (Name): |
|
| Vet address: |
|
| Vet phone: |
|
| Please list all pets (as an adult) you have had in the past 5 years, and where they are now: |
|
| If deceased, what were the causes: |
|
| Do you plan to enroll your new pet in training and where?: |
|
Please explain whether you would have a problem with any of the following situations and how you would deal with them (training is not an acceptable answer):
chewing, jumping, digging, scratching, houstraining mistakes, running away and other mischievous behavior |
|
| What behavior would cause you to return your pet to the adopting organization?: |
|
| Have you adopted a pet from another organization before?: |
|
| If yes, where and when, and pets name: |
|
| Have you ever applied to adopt an animal from another shelter?: |
|
| If so, who, when and where?: |
|
| Have you ever brought an animal into a shelter or animal control facility?: |
|
| If yes, please explain: |
|
| Please provide the name and telephone #s of at least two personal references (non-family) that can be contacted as part of our routine screening process. Examples of acceptable references would be neighbors, co-workers, employers, fellow club or church members, etc.: |
|
| Briefly describe how your pet would spend their day: |
|
IAR and the coalition take every effort to protect the privacy of each adoption applicant; however, by completing and submitting the above adoption application, you are agreeing that you are 21 years of age or older and that IAR or the coalition has the right to verify any information on the application.
Thank you for rescuing! |
|
| |
