Dog Rescue Shelter, Inc. is a non-profit
dog rescue organization in Anytown, USA.

Adoption Application

Your text goes here.

Name of animal (from the Petfinder adoption list) or breed/characteristics that you want:

First and Last Name:

Email Address:

Street Address:

City:	State:	Zip:

Daytime Telephone:

Evening Telephone:

Employer:

Type of dwelling (Apartment, single family residence, duplex, townhome, condo, loft, etc?)

Do you: Own Rent Live at Home

If you rent: Are pets allowed? Yes No
(written proof required)

Landlords Name:

Landlords Phone:

Does your landlord require a security deposit? Yes No
(proof of payment required before the adoption can be completed)

Length of time at current residence?

If less than one year at current residence please provide previous address:

Length of time at previous residence?

Do both adults work outside the home? Yes No

Number of adults in the home:

Number of children in the home and ages:

Do you currently have other dogs or cats? Yes No

If yes, please give names, breeds and ages, as well as any other relevant information about the pet: (Type N/A if not applicable.)

If you have current pets, are they spayed/neutered? Yes No

if no, please explain as it is a requirement for approved adoption applications: (Type N/A if not applicable.)

If you don’t currently own a pet, have you owned one in the past?
Yes No

If yes, please explain why the pet is no longer with you:
(Type N/A if not applicable.)

Name/address/phone # for current veterinarian (To check current pet records.) or veterinarian that you plan to use (if you don’t have a current pet.)

Where will your pet stay during the day?

Where will your pet stay at night?

If you are adopting a cat/kitten are you planning to have it declawed? Yes No

If you are adopting a cat/kitten are you planning to let it go outside? Yes No

Why do you wish to adopt this type of animal?

If you selected other above, please specify:

I certify that the information given on this application is true and correct. If I am approved to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal.

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