| E-mail Address: * | |
| 1. Name or ID of pet interested in. | |
| 2. Please explain why this pet is right for you. * | |
| 3. Please provide your FULL NAME. * | |
| 4. Please provide your age. Please note if you are under 18, your parent or guardian must be the ones to fill out the application. * | |
| 5. Please give your street address. * | |
| 6. Please give your city. * | |
| 7. Please provide your state. * | |
| 8. Please provide your zip code. * | |
| 8a. Please provide a home phone and a alternate number to reach you at. * | |
| 9. Please give employers name. If not employed please explain how you will provide care for this pet. * | |
| 9a. Please provide your employers phone number. * | |
| 9b. Do you run a daycare from your home * | |
| 10. Please provide residence info. * | |
| 11. If you live with someone else who owns the home, please provide their FULL name(this includes significant others, parents, grandparents, room mate)If the home is in your name please put your name in this box. * | |
| 12. How long have you lived at the above address? * | |
| 13. If you rent or live in mobile home park, please provide landlord or park name and number. * | |
| 14. Is your yard securley fenced? * | |
| 15. If fenced please check answer that best descibes your fence area. * | |
| 16. If you do not have a fenced area please describe how you will potty play or exercise your pet? | |
| 17. Will this be an inside or outside pet? * | |
| 18. If your pet is outside, please describe the type of shelter you will have for it. | |
| 19. If outside how long will pet be outside? * | |
| 20. List All people living in the home(even ones on a part time basis), please give first and last NAMES and AGES and relationship to applicant please. Failure to list people living in may mean your application is rejected. * | |
| 21. Please list all pets(names and breeds) in past 5 years (include ones you now have, also list ANY pets in home that belong to someone else) if you no longer have one or more of these pets please explain what happen to pet or pets. | |
| 22. Were the above pets spayed or neutered? If not please explain why not. | |
| 23. Please provide the vet name and number that above listed pets have seen. This includes vets they may of seen from other towns or states you may of lived in. If you have no vet history please type in No Vet History. * | |
| 23a. Please provide full name of person the vet account is under. * | |
| 24. Is someone home during the day? * | |
| 25. How long will pet be left alone in a 24 hour period? * | |
| 26. Do you expect to have a child or move in the near future? * | |
| 27. If reference to the question above, what will happen to the pet? * | |
| 28. If approved to adopt, will you spay or neuter your pet by six months of age? * | |
| 29. If no to the question above, please explain why not. | |
| 30. If you adopt a pet from Pound Buddies Rescue and your pet does not work out you must return the pet to us at your expense, do you agree to this? * | |
| 31.Will you agree to a home visit from Pound Buddies Rescue or a representative of Pound Buddies Rescue? * | |
| 32. If No to the above question, please explain why not. * | |
| 33. Please provide personal reference 1. Please provide name and phone number. * | |
| 34. Please provide personal reference 2. Please provide name and phone number. * | |
| 35. Please provide personal reference 3. Please provide name and phone number. This one must be a family member not living with you * | |
| 36. I understand that my electronically-generated signature below is valid as a means of legal and binding signature for the purpose of this adoption application. * | |
| 37. Please type in your Full name * | |
| 38. Todays Date * | |
| 39. Please call your vet within 24 hours of filling out this application to authorize them to speak to us. Do you agree to do this? * | |
| 40. In reference to the question above, failure to call your vet may result in your application not being processed. Do you understand this? * | |
| 41. We will call your vet within 1-24 hours after receiving your application, this does not include weekends. If you have not called them, we will only try 2 times to contact you to do this. After that you may lose out on pet you are interested in. Do you understand this? * | |
| Please use this area for any comments or extra info you want to share. | |
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| * Required | |