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Adoption Application
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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
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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
*
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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
*
Please select
1
2
3+
Relationship
Children in household
*
Please select
0
1
2
3+
Ages
Is the whole family in agreement to adopt a pet?
*
Yes
No
Describe household
*
Active
Noisy
Quiet
Other
PLEASE EXPLAIN
Is anyone in the house allergic to pets?
*
Yes
No
Who and what kind of pets?
EMPLOYMENT INFORMATION FOR APPLICANT
Employer
Position
How long?
City
State
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
EMPLOYMENT INFORMATION FOR CO-APPLICANT
Employer
Position
How long?
City
State
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zipcode
PERSONAL REFERENCE
Name
*
Address
*
Phone Number
*
BACK
NEXT
CURRENT PET(S)
Have you had pets in the past or do you currently have pets?
*
Yes
No
HOW MANY?
Please select
1
2
3
4
5+
Name
Breed
Age
Gender
M
F
Spayed/Neutered
Y
N
Last vet visit
Name
Breed
Age
Gender
M
F
Spayed/Neautered
Y
N
Last vet visit
Name
Breed
Age
Gender
M
F
Spayed/Neautered
Y
N
Last vet visit
Name
Breed
Age
Gender
M
F
Spayed/Neautered
Y
N
Last vet visit
Name
Breed
Age
Gender
M
F
Spayed/Neautered
Y
N
Last vet visit
Current Veterinarian Name
Phone Number
All vaccinations current?
*
Yes
No
Do your pets have any behavioral problems or chronic illnesses?
*
Yes
No
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
No
What size & type of yard?
How many hours a day will the dog or puppy be home alone?
*
Breaks in between?
*
Yes
No
How many days per week?
*
Please select
1
2
3
4
5
6
7
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?
*
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