Title *
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Name 2
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The name of the second person that is a part of this adoption
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Home Phone *
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(xxx-xxx-xxxx)
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Mobile/Pager
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(xxx-xxx-xxxx)
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Email Address *
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Address *
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City *
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State *
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Zip Code *
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Length of Time at the Present Address *
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Adults (Number of people in the household)
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Children (Number of people in the household)
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Please specify the age of all children in the Specify your own value field (separate by commas)
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Do you rent or own? *
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If you rent, please provide your Landlord's name & phone number (or a copy of your lease)
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A scanned copy of your lease can be attached to this application using the Attach file icon in the ribbon above.
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Employer
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Names of the animal(s) you are interested in *
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List the dog(s) you are interested in, i.e. Fido, Rover, etc
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When were you hoping to adopt/foster *
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Desired characteristics of adoptable animal *
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Reason(s) you are interested in adopting a pet?
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Check all that apply
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For how long have you been considering adopting a companion animal? *
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Is this your first companion animal?
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Do you currently have other companion animals?
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Please fill out detailed information on the next field if you answer YES to this question.
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Current companion animal(s)
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Please specify detailed information about ALL of your current companion animal(s) by listing information such as type of animal, age, sex, breed (or mix of breeds), weight, spayed/neutered, current on vaccinations, and where the companion animal currently resides.
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Have you applied to this rescue before?
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Have you applied to any other rescue organization before?
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1 Name of Shelter
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1 Date Applied
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(mm/yyyy)
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2 Name of Shelter
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2 Date applied
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(mm/yyyy)
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How do you plan to introduce your companion animal to other animals and/or people in the household? *
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Companion animal adjustment period *
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Are you prepared to spend several weeks or, perhaps months, waiting for your new companion animal to adjust to their new environment? And for you to adjust to this animal?
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Who is or will be your Veterinarian? *
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Please list contact info such as name, address, and phone number
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How much money do you anticipate on spending on your new companion animal's annual doctor visits? *
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What yearly vaccines will your companion animal receive? *
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Do you have any of the following: *
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(please specify how high your backyard fence is using Specify your own value field)
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What is the longest period of time you would leave your companion animal unattended outside? *
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Where will your pet be kept during the day? *
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Where will your pet be kept at night? *
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What is the most amount of hours the animal will be left alone? *
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What brand of food will you feed your pet? *
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What are your beliefs regarding spaying/neutering? *
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What are your beliefs regarding obedience training? *
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Who will be primarily responsible for feeding/caring for your new pet? *
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What do you believe is the average life expectancy of a dog/cat? *
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How did you hear about our shelter? *
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Have you ever surrendered an animal into a shelter?
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If yes, what were the circumstances?
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How would you handle the animal jumping on furniture/counters/tables? *
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How would you handle the animal destroying/scratching the furniture? *
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Rich text editor How would you handle the animal destroying/scratching the furniture? Required Field
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How would you handle the animal chewing? *
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Rich text editor How would you handle the animal chewing? Required Field
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How would you handle the animal barking? *
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How would you handle the animal urinating/defecating where it is not acceptable? *
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Rich text editor How would you handle the animal urinating/defecating where it is not acceptable? Required Field
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How would you handle the animal keeping you awake at night? *
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How would you handle the animal shedding excessive hair? *
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How would you handle the animal ruining your favorite article of clothing? *
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How would you handle the animal biting/play biting? *
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How would you handle allergies that a current household member may develop to your new companion animal? *
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How would you handle medical expenses (emergencies and diagnosis of a medical condition) involving your companion animal? *
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How would you handle moving/finding new housing involving your companion animal? *
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When home alone, the dog will be (check all that apply) *
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How will you exercise the dog (check all that apply) *
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Reference1 - Name *
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Reference1 - Phone Number *
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(xxx-xxx-xxxx)
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Reference2 - Name *
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Reference2 - Phone Numner *
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(xxx-xxx-xxxx)
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E-Signature1 | Print Your Name *
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E-Signature1 | Date *
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(mm/dd/yyyy)
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E-Signature2 | Print Your Name
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E-Signature2 | Date
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(mm/dd/yyyy)
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Attachments
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