Applicant's Information
Applicant's Full Name:
Applicant's Home Address (include Street, City, State and Zip):
Applicant's Home Phone Number:
Applicant's Age:
Applicant's Drivers License Number:
State issued:
Applicants Work Phone Number:
Applicants Work Address:
Applicants E-Mail address:
Spouse's Information
Spouse's Full Name:
Spouse's Age:
Spouse's Work Phone Number:
General Information
Best Time to Call:
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(In order to be approved to adopt a pet, we must do a vet reference check.)
Name of Applicant's Current Veterinarian:
Veterinarian's Address:
Veterinarian's Phone Number:
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1. Why do you want to bring a new pet into your home?
2. How many people reside in your household?
3. Is everyone in your household in agreement on adopting a pet?
4. Is there a pet on our web site that you are interested in? If so, please specify.
5. Who will be responsible for the feeding, grooming, housebreaking and training of this pet?
6. Have you had pets in the past? (If no, then skip to question # 10)
7. What type of pet(s) did you have in the past and how many?
8. How many years did you own the pet(s)?
9. Reason for no longer owning the pet(s)?
10. Do you have any pet(s) currently? List type, breed, age, & sex.
11. Has any pet of yours ever gotten lost? If yes, please provide explanation.
12. Has any pet of yours ever been poisoned? If yes, please provide explanation.
13. Would you allow a dog to ride loose in the bed of a truck?
14. What were the circumstances of your last pet's death?
15. Would you leave a pet unattended in the yard?
.
16. Are your current pets spayed/neutered? If not, please explain.
17. Do you have children at home? If so, how many and how old are they?
18. Do you live in a house, apartment, condominium, or trailer?
19. Do you rent, or own?
NOTE: If you rent, you MUST have written permission from your landlord stating that you are allowed to keep a pet in the apartment.
20. May we contact your landlord?
21. Landlord's Name?
22. Landlord's Phone Number?
23. Does your residence have a yard?
24. If yes, is it fenced?
25. If yes, how much is fenced and what type of fencing do you have, how tall is it etc..?
26. Where will the pet stay during the day? Inside Outside Both:
27. Where will the pet stay during the night? Inside Outside Both
28. How much time will the pet spend outside on an average day?
29. How many hours will the pet be left unattended on an average day?
30. When no one is home, where will the pet be kept?
31. Where will the pet sleep?
32. What provisions will be made for your pet when you go on vacation?
33. How often will adults be away from home on business/vacations?
34. Specify if you have a gender and breed preference for the pet you want to adopt.
35. Specify if you have a coat preference for the pet you want to adopt. (ex. shorthair, longhair?)
36. Would you be willing to expand on your gender, breed, and color preferences?
37. Have you ever taken an animal to a shelter? If yes, please explain.
38. How long have you been looking for a pet?
39. Where have you looked for a pet prior to contacting Waggin' Tails Pet Rescue?
40. Do any members of your household fear animals? Please specify details.
41. If you answered yes to Question 40, how will you manage the transition of a new pet into your home?
42. Will you assume all financial responsibilities for the pet you adopt,
veterinary care, good quality food, licensing, etc.?
43. Are you planning to change residence in the near future? Please specify details.
44. Is anyone in your home allergic to animals? Please specify details.
45. Are you familiar with the animal laws and regulations in your area?
46. Is the pet for which you are applying going to be a gift?
47. If you answered yes to Question 46, does the recipient know they are getting this gift?
48. Do you understand that pets you adopt from Waggin' Tails Pet Rescue will be spayed/neutered?
49. If Waggin' Tails Pet Rescue recommends that you take obedience or agility training classes with
your pet, will you do so?
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References
Please provide names and phone numbers of three pet-owning references
(neighbors, friends, etc.). Relatives MAY NOT be used as references.
Reference #1:
Name of Reference #1:
Relationship of Reference #1 to Applicant:
Address of Reference #1:
Home/Evening Phone Number of Reference #1:
E-Mail Address of Reference #1:
Reference #2:
Name of Reference #2:
Relationship of Reference #2 to Applicant:
Address of Reference #2:
Home/Evening Phone Number of Reference #2:
E-Mail Address of Reference #2:
Reference # 3:
Name of Reference #3:
Relationship of Reference #3 to Applicant:
Address of Reference #3:
Home/Evening Phone Number of Reference #3:
E-Mail Address of Reference #3:
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By signing below, I further certify that the information I have provided on this form is true, correct, and accurate.
50. I understand and agree that falsification of any of the above information is grounds to disqualify my adoption application and nullify all adoption(s) and/or adoption agreements between the applicant and Waggin' Tails Pet Rescue.
Signature:
Date:
