Adoption Application

Pet Information

1. What animal are you applying for? *

2. If the animal you are applying for is no longer available, would you be interested in another pet from our rescue? *

Yes

No

3. How did you hear about this animal? *

(Check any that apply)

Applicant Information

4. First Name

First

5. Last Name

Last

6. Street Address *

7. City *

8. State

9. Zip *

32. What county do you live in? *

10. Primary Phone Number *

11. Email

12. Your Age *

13. Employment Status *

(Check all that apply)

14. Place of Employment *

(If retired or unemployed enter N/A)

15. Work Phone *

Co-Applicant

16. Is there a co-applicant applying? *

Yes

No

17. If yes, please list co-applicants name:

18. Co-applicants phone

19. Co-applicants email

Emergency Contact (must live outside your home)

20. Emergency contact's name *

21. Relationship to emergency contact *

22. Emergency contact's phone number *

Home Life

23. What type of home do you live in? *

24. Do you own your home? *

Yes

No

If you do not own your home, please provide your landlord/homeowner's info:

25. Landlord Name

26. Landlord Street

27. Landlord City

28. Landlord State

29. Landlord Zip

30. Landlord Phone

31. Landlord Email

33. How long have you lived at your residence? *

If at your residence less than 2 years, please tell us where you lived before?

34. Former Street

35. Former City

36. Former State

37. Former Zip

38. Do you have a fenced in yard? *

Yes

No

39. If yes, what type of fence and how high?

40. How will you exercise your pet? *

Household

Please list all of the people living in your home.

41. Name of person living in your home *

Age

Relation to You:

42. Name of person living in your home

Age

Relation to You:

43. Name of person living in your home

Age

Relation to You:

44. Name of person living in your home

Age

Relation to You:

45. If children live with you, have they been around pets before?

Yes

No

Please list all the children that do not live with you, but frequent your home.

46. Name of children who frequent your home.

Age

Name of children who frequent your home.

Age

Name of children who frequent your home.

Age

References (provide 3)

(REFERENCES must be not related to you and no one living in the household)

47. First Reference Name *

First Reference Phone *

First Reference Address *

48. Second Reference Name *

Second Reference Phone *

Second Reference Address *

49. Third Reference Name *

Third Reference Phone *

Third Reference Address *

50. Your Veterinarian name and address *

51. Veterinarian phone number *

52. Names of animals seen by this veterinarian *

About the pet you are interested in

54. Are you able to care for your pet if it should need costly supplements and/or emergency surgery? *

Yes

No

55. Enter a dollar amount for how much money you expect your yearly expenses to be for this pet? *

Please consider: food, vet bills, heart worm/flea-tick preventative, grooming, training, toys, bedding, etc.

56. What would you do if the pet needed medical care that you could not afford?

57. What is the maximum number of pets you intend to have at one time?

58. Is this pet intended to be a gift? *

Yes

No

59. Are you willing to give this pet enough time to adapt to its new environment and family members? *

Yes

No

60. If you are applying for an animal not fully house-trained, what house-training method will you use? *

61. What will you do if/when the animal has an accident? *

62. Do you plan on enrolling your new dog in obedience training? *

Yes

No

63. Who will be the primary caretaker of this pet? *

64. Approximately how many hours a day/a week will the pet be left alone? *

65. Where will the pet sleep at night? *

66. When no one is home, where will the pet be kept? *

67. Who will care for the pet when you are away? *

68. Have you ever bred any animals? *

Yes

No

69. Have you ever surrendered an animal to a shelter, rescue, or given one away? *

Yes

No

If yes, please explain:

Animals currently living in your home

70. Pet's Name Currently in Your Home

Breed

Gender

Age

Where did you get this pet?

Spayed/Neutered?

Yes

No

Second animal currently living in your home

71. Pet's Name Currently in Your Home

Breed

Gender

Age

Where did you get this pet?

Spayed/Neutered?

Yes

No

Third animal currently living in your home

72. Pet's Name Currently in Your Home

Breed

Gender

Age

Where did you get this pet?

Spayed/Neutered?

Yes

No

Fourth animal currently living in your home

73. Pet's Name Currently in Your Home

Breed

Gender

Age

Where did you get this pet?

Spayed/Neutered?

Yes

No

Animals that frequent your home and are not yours:

74. Pet's Name that Frequents Your Home

Breed

Gender

Age

Spayed/Neutered?

Yes

No

Additional animal that frequents your home and is not yours:

75. Pet's Name that Frequents Your Home

Breed

Gender

Age

Spayed/Neutered?

Yes

No

Please list your previous (deceased) pet(s) information

76. Previous Pet's Name

Breed

Gender

Age

Where did you get this pet?

Spayed/Neutered?

Yes

No

77. Has anyone in your house (living or visiting) ever been convicted of an animal-related charge? *

Yes

No

78. Is anyone in the household allergic to any animals? *

Yes

No

If yes, please explain:

79. If you should have to move, are you willing to restrict your choice of housing to places where the type and breed of you pet(s) are allowed? *

Yes

No

80. Have you thought about how ALL life changes such as moving, getting married/roommate/divorced, having children, going to college, getting new furniture, job change, etc. could affect your ability to keep or care for this pet? *

Yes

No

81. Have you checked with your insurance company about Breed-Specific Legislation in your area? *

Yes

No

82. If your insurance company decides that they will not insure you, as long as you own the pet you have adopted, are you willing to change insurance companies?

Yes

No

Adopter Agreement

83. I am at least 25 years old or own my own home. *

Yes

No

84. I agree to have a crate and continue to crate train my adopted pet. *

Yes

No

85. I am committed to keeping my pet(s) until they die due to old age/illness, even if my family, life, job changes, or I move. *

Yes

No

86. I agree to accept immediate & full responsibility for ownership of this pet(s), to properly license the adopted pet(s), and to follow all local and state regulations regarding pet ownership and control. *

Yes

No

87. I agree to provide the pet with yearly veterinarian examinations, vaccinations, dental work, etc. *

Yes

No

88. I agree to provide the pet with a safe and loving home, food, water, shelter (inside the home) and sufficient exercise. I will never allow the dog to live outside, nor keep the pet outside if I am not on the property. *

Yes

No

89. I agree to never euthanize my pet(s) unless the veterinarian recommends euthanasia because of tremendous suffering. *

Yes

No

90. I agree to keep this pet(s) as a companion. I will consider this pet(s) as part of the family. *

Yes

No

91. I agree to NEVER surrender the pet to a third party without the express approval of It Takes A Village Animal Rescue, Inc. This includes to other family members that are not listed as Applicant or Co-Applicant on this application. *

Yes

No

92. I understand that I will be asked to give a non-refundable donation to It Takes A Village Animal Rescue, Inc. to help with spay/neutering and veterinary care of current and/or future rescued pets. *

Yes

No

93. I agree to surrender the pet to It Takes A Village Animal Rescue, Inc. if, in the opinion of two, It Takes A Village Animal Rescue, Inc. representatives, the animal is not being properly cared for, such as being neglected, abused or the lack of veterinary care or any reason that It Takes A Village Animal Rescue, Inc. deems as not properly cared for. *

Yes

No

94. I understand that It Takes A Village Animal Rescue, Inc. takes every precaution to ensure the health of its animals. No guarantee can be given regarding the condition of the temperament of the pet(s) up for adoption. *

Yes

No

Applicant Signature

95. Applicant Name *

96. Today's Date *

97. If you have any additional information that will help us process this application, please comment below.

Adoption & Foster Application

Congratulations

You’ve Decided to Save A Life!

ADOPTION FEES

Pet Information

Applicant Information

Co-Applicant

Emergency Contact (must live outside your home)

Home Life

Household

References (provide 3)

About the pet you are interested in

Animals currently living in your home

Second animal currently living in your home

Third animal currently living in your home

Fourth animal currently living in your home

Animals that frequent your home and are not yours:

Additional animal that frequents your home and is not yours:

Please list your previous (deceased) pet(s) information

Adopter Agreement

Applicant Signature

Adoptable Pets

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