Hope Rescues Adoption Application 3701 Coronado Dr
Date (mm/dd/yyyy) :
Name and/or breed of the Pet you are interested in (if known):
Driver License Number :
Applicant's Name:
Present Street Address:
City: State: Zip:
How long at this address?
Yes
No
Are you planning to move in the near future ?
If yes, what will you do with your pet(s) ?
Home Phone Number:
Cell Phone Number:
Work Phone Number:
E-mail Address:
Are you over 18 years of Age ?
Yes
No
Occupation:
How long are you away from home each day ?
hrs
Your Current Home Environment
Own
Rent
Pick One
House
Duplex
Apartment
Condo
Mobile Home
Other
Do You Rent or Own ?
Type of Home you currently live in:
The following questions only apply if you do not own your own home:
Name of apartment complex, mobile home park or landlord (if applicable) :
Yes
No
Please list pet restrictions, if any (i.e., weight, number of pets allowed, etc.
Yes
No
Do you have a fenced yard ?
The following questions only apply if you have a fence
Pick one
Wood
Chain Link
Vinyl
Other
Ft.
Members Within Your Household
How many Adults live in your home ?
How many children live in your home ?
List Ages:
Yes
No
Do any members of your household have allergies ?
Information of Current Pets:
Please list all of the pets currently in your
Yes
No
Are any of these pets kept outdoors ?
Yes
No
Are all of your pets spayed or neutered ?
If you answered "No", which pets are not spayed / neutered ?
Veterinarian Information:
Veterinarian's Name:
Vet's Address:
Vet's Phone Number:
Pet History:
Have you had any other pets in the last five years that are
Yes
No
If yes, list the Type of Animal, Sex, Age, Spayed /
Yes
No
Have you adopted any pets from a rescue group or animal shelter in the past?
If yes:
Where is this pet now?
Pet Specifics:
Male
Female
No Preference
What gender of dog are you interested in adopting?
What age pet are you interested in adopting?
Pick One
Adult (over 1 yr. to 3 yrs)
Adult (over 3 yrs )
Older Puppy (5 mos. to 1 yr.)
Puppy (Younger than 5 mos.)
No preference
Pick One
Toy (Under 10 lbs)
Small ( 11-25 lbs)
Medium (26-50 lbs)
Large (51-90 lbs)
Giant (Over 90 lbs)
No preference
If a dog, What size dog are you interested in adopting?
Pick One
Very Active (needs lots of exercise)
Active (needs a moderate amount of exercise)
Sedentary (couch potatoe)
No preference
How active would you like your pet to be?
I want this pet for: :
Breeding
Companion
Child's Pet
Hunting
Gift
Guard Dog/Protection
Work / Farm
Companion for other pet
Other
While holding
How long have you been looking for a pet?
My pet will be kept:
Pick One
Mostly indoors
Mostly outdoors
Equally indoor / outdoor
Undecided
If your pet is left outdoors, what type of shelter will be provided?
Will you be using a tie-out or chain to secure the dog?
When your pet is left by itself, the pet will stay:
Pick One
Outside
Indoors in a crate
In a restricted area indoors
Allowed to roam free indoors
Where will your pet sleep at night?
How long will your pet be left by itself during the daytime?
If you live on acreage in the country, how will you
Care and Training of your Pet
Who will be responsible for the socialization,
Yes
No
Would you be interested in attending training sessions?
Who will be responsible for housetraining this pet?
Yes
No
Are you interested in information on housetraining?
Are you interested in information on obedience training?
Yes
No
There are times when unexpected and often very expensive
Yes
No
List your personal reasons for wanting a pet:
Are you willing to allow a representative of our group visit your residence?
Yes
No
Use this space if you have any additional
Please enter your initials in the space provided after each statement
I/we, the undersigned adopting party, understand and agree to the following terms and
1. To return the pet to the Rescue Program if unable to keep the
2. To notify the Rescue Program if the pet is lost or stolen and to
3. To never allow this pet to be trained for or used for protection or
4. To treat this pet as a family pet with affection and kindness,
5. To provide regular veterinary care, including annual shots,
6. To always keep this pet within a fenced yard - not on a chain, or
7. To never transport this pet unconfined in an open vehicle such
8. To regularly check the tightness of any collar. To affix any
9. To notify the Rescue Program of the pet's annual progress
10. To notify the Rescue Program if I / we move
11. To allow the Rescue Program to periodically check on this pet.
12. To contact the Rescue Program, a veterinarian, or an
13. That any pet over the age of 6 months and not altered prior to
14. I authorize my vet to release pet information to Hope Rescues
I/we further understand and agree that:
In consideration of the adoption of this pet, I/we agree to assume full responsibility for
By submitting this application electronically I certify the information I have provided is
Your Name Date:
