First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Which animal are you interested in
Choose an animal: Female chocolate puppies Missy

Referred by

In what type of home do you live*
Choose one: Apartment Condominium Trailer House Other Military Housing

Do you own or rent your home*
Choose one: Rent Own

What type of area is your home in?*
Choose one: Rural Suburban Urban

Are there any size or amount restrictions on pets where you live?*
Choose one: Yes No N/A

If so what are they?

Landlord's name and phone number:

Size of living area*

Size of yard*

Is the yard fenced*
Choose one: Yes No

What type of fence*
Choose one: Privacy Chain Link Invisible

What is the height of the fence*

How many hours will pet be left alone per day?*

During what time frame?*

Do you plan to keep your pet inside, outside, or both?*
Choose one: Inside Only Outside Only Inside and Outside

If inside and outside, where will the pet be kept during the day:

If inside and outside, where will the pet be kept at night:

Will pet be permitted on:

Would you be willing to permit a home check by a volunteer*
Choose one: Yes No

Are you willing to stay in touch with the foster parent?
Choose one: Yes No

Is there any aspect of your home an animal could affect (white carpet, antiques, whicker, etc.), if yes, explain*

Do you or anyone in your family have allergies to hair or dust:*
Choose one: Yes No

Are you often away for extended periods of time (travel):*
Choose one: Yes No

If so, will you board the pet, use a petsitter, or take with you?*
Choose one: Board the pet Use a petsitter Take with you

Do you currently own pets?*

Number of cats:*

Number of Dogs:*

Are they current on vaccines?*
Choose one: Yes No N/A

Are your cats declawed:*
Choose one: Yes No N/A

Have your dogs been around cats before?*
Choose one: Yes No N/A

Are there any animals in the house that are not spayed/neutered*
Choose one: Yes No

If yes, explain

Please list the species, breed, sex and ages of all animals currently owned

Have you ever owned a cat?*
Choose one: Yes No

Have you ever owned a dog?*
Choose one: Yes No

Why do you want this pet?*

Some rescues have pre-existing health conditions/problems that may require further care by the adopter (skin problems, cataracts, etc). Would you adopt an animal that has health problems?*

Are you aware of the yearly costs of maintaining a health pet?*
Choose one: Yes No

There are yearly vaccines, flea and heartworm prevention, dental care, healthy food,accessories, as well as many unforeseen items or circumstances such as accident or illness. Vet care can total in the hundreds or even thousands for extensive health issues. Are you prepared to meet these requirements?*
Choose one: Yes No

May we contact your veterinarian?*
Choose one: Yes No N/A

Hospital and/or doctor name and number:

Do you have children living at home?*
Choose one: Yes No

If so, ages?

How much adult supervision of animal and child will be provided
Choose one: Maximum Some Minimal None

If no children reside with you, how often will the pet come in contact with children

What temperaments do you desire in your pet
Choose one: Leader Follower Friendly Aloof Outgoing Shy Demands attention Little attention Protective Quiet

Activity level desired
Choose one: High Moderate Low

Some animals are lively and curious in the house, they like to play with you and follow you around. Do you think an active pet would annoy you?*
Choose one: Yes No

How would you encourage, reinforce your animals' appropriate behavior*

Are all members of your household aware you are adopting a pet?*
Choose one: Yes No

Who will be the primary caretaker?*

Should you be unable to care for this animal, due to health reasons, do you have a family member/guardian that will take over his/her care? Please specify:*

Are you planning to take your new dog/puppy to obedience class*
Choose one: Yes No

Have you ever crate trained a dog*
Choose one: Yes No

Are you willing to crate this dog if needed*
Choose one: Yes No

Are you willing to pay the $150-$350 adoption fee to help defray the expenses associated with rescue and care and to help SVPR continue it's rescue efforts*
Choose one: Yes No

Have you ever surrendered an animal to a shelter or rescue organization, and if so which one:*

What is the disposition of your previous animals? [ ran away, stolen, sold, given away, euthanized, other ]*

If euthanized, why?

If passed away, what was cause of death

How long were these animals part of your family

Please provide the name, phone number and relationship of 2 references*

I attest that all answers that I have provided on this application are correct. I understand that Suntree-Viera Pet Rescue and it’s successors and assigns has the right to refuse any applicant for any reason.*
Choose one: Yes No