Application for Adoption

Date *

Name of Pet you are interested in *

Are you (the person filling out this application) at least 18 years of age? *

Yes

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone *

Email Address *

Occupation? Spouse or Partner's Occupation? *

Description of Pet (Breed, Coloring) *

Why do you want to adopt this breed of dog? Please tell us what you know about the breed of dog you are interested in? *

Do you Plan on keeping your pet: *

Inside

Outside

Both

If "both" please explain. *

Do you *

Own

Rent

How long have you lived at this address? *

If you rent, please provide landlord's name and phone number. *

Is there a limit as to how many pets you can have where you live? If so, what is it? *

Is there a weight limit to the pets allowed? If so, what is it? *

Are there any breed restrictions where you live? If so, what are they? *

If you have any cats or dog in your home that are not spayed or neutered, would you be willing to get them done? (We can provide low cost options) *

Yes

N/A

Please list all pets you currently have:

	Pet 1	Pet 2	Pet 3	Pet 4
Name	Pet 1	Pet 2	Pet 3	Pet 4
Species	Pet 1	Pet 2	Pet 3	Pet 4
Breed	Pet 1	Pet 2	Pet 3	Pet 4
Age	Pet 1	Pet 2	Pet 3	Pet 4
Sex	Pet 1	Pet 2	Pet 3	Pet 4
Spayed/Neutered?	Pet 1	Pet 2	Pet 3	Pet 4
(Dog) kept Current on monthly Heartworm Prevention?	Pet 1	Pet 2	Pet 3	Pet 4
Current on Vaccinations?	Pet 1	Pet 2	Pet 3	Pet 4
Microchipped?	Pet 1	Pet 2	Pet 3	Pet 4
Kept current on monthly Flea Prevention?	Pet 1	Pet 2	Pet 3	Pet 4

Please list each pet you have owned in the last 5 years that is no longer with you and the reason why. If deceased, what year did they pass away and what was the cause? Please list n/a in box if none in the past *

List all members of your household and their ages: *

Name and Phone of current vet: *

If you don’t currently have a Vet, have you picked one out yet? If so, which one? *

When was your last vet visit and for what reason? *

Will you allow an WRW representative to visit your home: *

Yes

Are you willing to take responsibility for this pet for the rest of its life? *

Yes

Are you aware there is a period of adjustment for each rescue to it's new surroundings which may include potty accidents, chewing and digging, or other 'undesirable' behaviors? *

Yes

Are you willing to spend the necessary money for vet bills that may be incurred to keep your pet healthy, knowing in advance that the average yearly cost of having a pet is approximately $700 - $1,000? *

Yes

Who will be the primary caretaker for the pet (feeding, attention, training, exercise)? *

Where will the pet sleep? *

How many hours a day on average will your pet be left alone? *

Where will the pet stay while you are away? *

Have you ever sold, given away or surrendered a pet to a shelter or another individual? If yes, please explain: *

Yes

Please Explain:

What will happen to this pet if you move? *

What will happen to this pet if you can no longer care for it? *

Are you familiar with using a crate to housetrain and provide a safe place for your pet to stay when you are away? *

Yes

If not, are you willing to learn and use this technique? *

Yes

N/A

If the adopted dog makes a mistake, please describe what sort of correction you will make *

Is your yard fenced? *

Yes

If yes, describe type of fence and approx. height:

Dogs need daily exercise! Please explain what kind of exercise you plan to provide: *

Will you consider obedience training classes or seek the help of WRW members to help you learn proven methods of dog training, if needed? *

Yes

Please provide 2 or more references (this will speed up approval process) *

I agree as an adopter, I will not be reimbursed for vet care or other extraneous costs not specifically approved, in writing, by an approved Who Rescued Who, partner. *

Agree

Disagree

I attest the information provided on this application is true and accurate to the best of my knowledge. I hereby permit Who Rescued Who (WRW) to contact my Veterinarian. I permit that if my adopted pet is not already altered I agree to take the animal to be altered and provide proof of alteration. If I miss the appointment set by WRW, WRW can take the adopted pet back into WRW’s possession, with no refund given. If for any reason I am unable to keep an adopted pet from WRW for its entire life, I will contact WRW and make arrangements to return the pet and no refund will be given. Further, I agree to not sell, give away or dispose of the pet in any other manner (except euthanasia for medical reasons at the advice of a licensed vet) without prior consent of WRW. *

Do Not Accept

Signature *

clear

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