First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Which animal are you interested in
Choose an animal: *Lost Girl (Home to Home) *Sally (Home to Home) *Scooby & Baloo (Home to Home) Alfie Annie and Oakley (Puppy) Badger Barley Beemer Bella (Recycle) Cardamon Charly Daisy Elmo (Cat) Fern Flory George Ghost Harley Harper Hawk (Puppy) Jack Jenny Lynn Jetta Katydid Kenzo (Ritzy) KiKi (Cat) Lego Lindy Mabel Malone Mardy (GrandPaws) Mario (Recycle) Mateo (Recycle) Miles Millie (Cat) MooMoo Mouse (Puppy) Ollie Oreo (Recycle) Padre Patsy Portia Princess (GrandPaws) Queenie Quinn Rascal Riley Rowan Samara Skyla Starla (Recycle) Stella Tartan Tater Tot (Puppy) Thistle Toffee Velvet Wild West Pups (Puppy) Winslow Winter (Cat) Yancy (Puppy) Zumie

Why are you interested in adopting a pet at this time*

Have you adopted a rescue pet before?*
Choose one: Yes No

What age group do you, the primary adopter, fall in?*
Choose one: 17-21 22-30 31-45 46-60 60 plus

Who is your Veterinarian*

List your other pets*

I certify that the information entered on this applicant is true. Enter your name and date*

How did you hear about us*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

Who in the household will care for the pet*

How many people reside in your household*

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No

If you rent, please enter your landlord's name and phone number*

What would make you return this animal?*
Choose one: not house trained moving divorce change in financial situation behavorial issues new baby

How much time will the animal spend alone during the day*

For cats only: Are you planning to declaw
Choose one: Yes No

Where will the animal be kept when you are not home*

Where will the animal be kept when you are home*

Where will the animal sleep*

Describe how you will train the pet*

What traits are you looking for in a pet

Have you ever given up a pet? If yes, please explain*

List at least one reference (who is not a family member)*