33%

Dog You Are Applying For:

Date

How were you referred to Rescued Rascals?

Why would you like to adopt an animal from us? (Please check all that apply)

Companion for Self

Companion for another pet

Companion for Child

Companion for another household member

Gift

Watchdog

APPLICANT / CO-APPLICANT INFORMATION

First Name*

Applicant

Last Name*

Applicant

Date of Birth*

Applicant

First Name

Co-Applicant

Last Name

Co-Applicant

Date of Birth

Co-Applicant

Street Address*

Apt #

City*

State*

Zipcode*

Email address*

Phone Number*

Applicant

Phone Number

Co-Applicant

Do you:*

Own

Rent

I am planning to move

How many years/months have you lived at this address?*

Applicant

Landlord/Condo Board Name

Landlord/Condo Board Contact

FAMILY HOUSEHOLD INFORMATION

(We require information on all adults/members living in the household)

Adults in household*

Relationship

Children in household*

Ages

Is the whole family in agreement to adopt a pet?*

Yes

Describe household*

Active

Noisy

Quiet

Other

PLEASE EXPLAIN

Is anyone in the house allergic to pets?*

Yes

Who and what kind of pets?

EMPLOYMENT INFORMATION FOR APPLICANT

Employer

Position

How long?

City

State

Zipcode

EMPLOYMENT INFORMATION FOR CO-APPLICANT

Employer

Position

How long?

City

State

Zipcode

PERSONAL REFERENCE

Name*

Address*

Phone Number*

CURRENT PET(S)

Have you had pets in the past or do you currently have pets?*

Yes

HOW MANY?

Name

Breed

Age

Gender

Spayed/Neutered

Last vet visit

Name

Breed

Age

Gender

Spayed/Neautered

Last vet visit

Name

Breed

Age

Gender

Spayed/Neautered

Last vet visit

Name

Breed

Age

Gender

Spayed/Neautered

Last vet visit

Name

Breed

Age

Gender

Spayed/Neautered

Last vet visit

Current Veterinarian Name

Phone Number

All vaccinations current?*

Yes

Do your pets have any behavioral problems or chronic illnesses?*

Yes

Please explain

Where do your pets stay during the day? How long are you usually gone during the day?*

Where do your pets stay at night?*

What kind of regular activities do you participate in with your family pets?*

Have you very rehomed/surrendered an animal? If yes, please explain. *

NEW PET INFORMATION

Desired Age?

Desired Size?

How much time are you prepared to allow for your new pet to adjust to their new home?*

Are you able to afford a bill of $200-$800 or more for emergency vet care?*

When you are out of town who will take care of your dog?*

How much time are you prepared to allow for your new pet to adjust to your new home?*

Describe in detail where your dog will spend the day:*

Describe in detail where your dog will spend the night:*

Do you have a fenced in yard?*

Yes

What size & type of yard?

How many hours a day will the dog or puppy be home alone?*

Breaks in between?*

Yes

How many days per week?*

How would you address digging with your new dog?*

How would you address barking with your new dog?*

How would you addressing chewing with your new dog?*

How would you address separation anxiety with your new dog?*

How would you address aggression with your new dog?*

This field should be left blank

Adoption Application

APPLICANT / CO-APPLICANT INFORMATION

FAMILY HOUSEHOLD INFORMATION

EMPLOYMENT INFORMATION FOR APPLICANT

EMPLOYMENT INFORMATION FOR CO-APPLICANT

PERSONAL REFERENCE

CURRENT PET(S)

NEW PET INFORMATION