Adoption Application

County Roads Rescue

Countyroadsrescue@gmail.com

Jacksonville, Tx

Adoption Application

All applications will be considered and requirements are based on each individual animal.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

How many children living in your home? *

Ages? *

Employers Name: *

Employer Contact Number: *

Length of Employment: *

Can we verify your employment? *

Yes

Do you rent or own your home? *

Rent

Own

Housing Type *

Home

Apartment

Mobile Home

Condo

What happens to this pet if you move? *

If renting, landord's name:

Landlord's phone number:

Were you given permission by your landlord to adopt an animal? *

Yes

Please upload written permission by landlord if applicable

What makes this particular animal a good fit for you, or what are you looking for in a new companion? *

Have you had experience with this particular breed? (If applicable)

Yes

How long have you been considering adding a new pet to the family? *

Is there a specific animal you’re interested in? If so, which one? *

How do you plan to exercise your pet?

What other kinds of animals do you have in your home? *

Have you adopted from a rescue before? *

Yes

How many hours will your pet be in the home alone? *

Will this be an inside, inside/outside or outside only pet? If outside only please explain: *

Are your other animals up to date on shots, and heartworm prevention *

Shots only

Yes

Are your other animals spayed/neutered? *

N/A

Yes

Cats only: If adopting a cat, do you plan to declaw? *

Cats only: Have any of your cats test positive for Feline Leukemia? *

Reference First Name: * 🛈

Reference Last Name *

Reference Phone Number *

Reference Email Address *

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Thank you for submitting an application for adoption!