Today's Date	* required
Full Name (First and Last)	* required
Spouse or other party name (First and Last)	* required
Home Address (No PO Box)	* required
City, State, Zip	* required
Home Tel#	* required
Cell Tel#	* required
Work Tel#	* required
Email Address	* required
Place of Employment (Name and address)
What is the best way and time to contact you?	* required
What is your age?	* required
What type of animal are you interested in adopting?
Which pet are you interested in adopting?
Why do you want to adopt a pet?
Does anyone living in your household have any known allergies to animals?	Yes No
If so, what kind of allergies?
Have you owned a pet before?	Yes No
What pets currently live in your household?
Are your pets kept indoors or outdoors? (Explain)
Please list the pets you have had within the past 5 years and explain what happened to them.
Are your pet(s) spayed and neutered?	Yes No
If not, please explain why.
Are your current pet(s)  up to date on all vaccinations?	Yes No
If not, please explain why.
Do you have a veterinarian?	Yes No
If so, please identify: Name/Clinic, Phone number, address
Will you allow above named Vet to release information regarding all current and former pets to Animal Rescue and Kare?	Yes No
Does everyone in the household know you are planning to adopt a pet?	Yes No
Do you own your home, rent your home/apt, or live with parents?	Own your home Rent your home/apt Live with parents
If renting, who is your landlord and give their phone number.
If you rent, does your landlord allow pets?	Yes No
How long have you been at this address?
Any children? What ages?
Do you have a completely fenced in yard, if so what kind and how high?
If the cat or dog will be allowed outdoors, how do you plan to make it clear to the animal  that this is its new home?
How long do you plan to keep this pet?
Should you move unexpectedly  what will become of the pet?
What behaviors would you consider unacceptable in your pet?
How would you correct these behaviors?
Do you agree to keep your pet on a leash while outdoors and off your property as required by local and state laws?	Yes No
How will you keep your dog confined to your property?
How many hours a day will your pet be alone?
Where will the pet stay when alone?
Where will the pet sleep?
If you travel, how will your pet be cared for?
If outdoors, what kind of shelter will be available to protect the pet from the elements?
Who will financially support this pet?
Do you plan on spaying or neutering the pet you want to adopt (if not already altered)?
Are you prepared for the costs involved in properly caring for a pet (ex. food, treats, toys, grooming, shots, etc.)?
Are you aware that if you adopt a pet from our rescue, you are required to return the pet to us at your own expense if you can no longer keep it?	Yes No
Would you object to an authorized member of ARK inspecting your residence?	Yes No
Please list at least 2 References (must include name, phone number, and address)
How did you hear about Animal Rescue & Kare and our adoption services?
If "INTERNET", please tell us from what site you found us.
Have you adopted a pet from us before or any other rescue organization?	Yes No
If so, which pet did you adopt from  us?
Which other rescue/organization have you adopted a pet from?
Anything else you think we might need to know or you want to tell us?
If you are not a local adopter, would you be able to pick up the pet?	Yes No
All of the information I have provided is true and complete to the best of my knowledge. I agree to provide the pet with adequate food, water, shelter, affection and medical care.	True False
Do you understand that We reserve the right to refuse any adoption to any person for any reason?	Yes No