Date:

Name*:

Age:

Co-applicant (spouse or significant other) name*:

Age:

Street Address*:

City/State/Zip*:

Email*:

Home Phone*:

Work Phone:

Cell Phone (if applicable):

*Required

EMPLOYMENT INFORMATION

Employer:

Fax:

Email:

PET OF INTEREST

Name of Pet:

Description of Pet:

Please list any question you may have about the pet you're applying for:

What is your reason for wanting to adopt? (Check all that appy)

Family Pet Child's Pet Watch Pet Companion

Hunting Pet Guard Pet for Business Gift

Companion for other pet Other (please explain)

HOUSING INFORMATION

OWN HOME RENT HOME

If renting, do you have permission from your landlord to have a pet?

YES NO

Is your home a: Single-Family Home Multi-Family Home Townhouse Apartment Mobile Home

Are you planning on moving in the next six months?

YES NO

If yes, will your pet go with you?

YES NO DON'T KNOW

Children's Age(s) (if applicable):

Additional Occupant(s) in home (if applicable):

Relationship to applicant:

Is anyone in your household allergic to animals?

YES NO

If yes, who and to what type(s) of animal(s)?

If yes, what do you propose to do about this?

Does anyone smoke inside the house?

YES NO

Do you have a fenced yard?

YES NO

If yes, what type of fence?: Chain Link Fence 4' Privacy Fence 6' Privacy Fence Invisible Fence Other

HISTORY

Have you had pets in the past?

YES NO

What happened to them?

Briefly describe the experience and skills that you feel will make you a great pet owner:

COMPANION ANIMAL INFORMATION

Other animals in home (include species, sex and whether spayed/neutered):

Housing situation for current animals (e.g., indoor, outdoor, crate, dog/cat door, etc.):

Indoor Outdoor Crate Dog/Cat Door Other

Housing situation for new animal:

Indoor Outdoor Crate Dog/Cat Door Other

How many hours per day would your pet be WITHOUT an adult caregiver?:

0-4 5-9 9-13 14+

Where will your adopted animal be when you are not home?:

Indoors Outdoors Crate Dog/Cat Door Other

IF YOU ARE ADOPTING A DOG:

What percentage of time would he/she be outside?

0-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100%

Do you know what heartworm disease is and how to prevent it?

YES NO

What type of heartworm and flea preventative do you plan on using?

Are you willing to pay for obedience school?

YES NO

IF ADOPTING A CAT

What percentage of time would he/she be outside?

1% or more Never

How will you train your cat to scratch appropriately? :

How will you deal with any litter box issues that might arise? :

What type of flea preventative do you plan on using?

Where will your adopted cat or dog sleep?

Indoors Outdoors Crate Dog/Cat Door Other

What are your plans to provide care for an animal in the event that you will be absent from your home for an extended period of time?

What ages and conditions of a pet (e.g., medical care, behavioral issues) would discourage you from adoption?

Have you ever had a serious behavior problem with a previous pet?

YES NO

If yes, please describe?

Do you have a dog or cat door?

YES NO

Have you always kept and ID tag (other than a rabies tag) with your name and phone number on your pets?

YES NO

Under what circumstances do you think it is OK to leave a pet outside alone and unsupervised in an unfenced area? (Check all that appy)

In a quiet subdivision On a lot of acreage In a rural area

When I know they are trained to come back Never

What circumstances, in your mind, justify giving up a pet? (Check all that appy)

Moving New baby Not getting along with other pets

Divorce Keeps getting out of fence Behavioral problems

Children lost interest If pet gets too big Shedding

Too time consuming Allergies Housebreaking problems

Medical problems Aggressive behavior Other (explain)

If you date or marry someone who doesn't like or want your pets, what would you do?:

If your pet develops a medical problem that becomes expensive, what would you do?: (Check all that appy)

Find another home for him Pay whatever it takes

Have him put to sleep Give him to a rescue group or shelter

Other (please explain):

Veterinarian name & phone number:

By signing (or typing) below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of rescue pet and possible removal of said pet from my home. Applicant must be 18 years of age or older. AARF reserves the right to refuse any applicant.

Signature:

Date: