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: Lily
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?
Is there a pet deposit? * Choose one: Yes No N/A
If so, amount:
Landlord's name and phone number:
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:
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
Has your cat been combo tested for FeLV/FIV(leukemia/AIDS)?* Choose one: Yes No N/A
Have your dogs been around cats before?* Choose one: Yes No N/A
List the breed or breed of your dog(s):*
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
Are you willing to spay or neuter your pets?* Choose one: Yes No
Do you plan to declaw the cat you are adopting?* Choose one: Yes No
If so, at what age?
And why?
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
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
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 willing to pay the $85 adoption fee to help defray the expenses associated with rescue?*
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
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
