Adopt — Route 66 Pet Rescue

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Adoption Application

Please do not navigate away from this page to insure your progress does not get lost.

Desired Animal's Name

Desired Animal's Breed

Desired Animal's Gender

Desired Animal's Age

Desired Animal's ID

Your Name

First Name

Last Name

Today's Date

YYYY

Your Email Address

Your Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Phone Number

(###)

###

####

Your Cell Phone Number

(###)

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Why do you want a pet?

Companion

Security

Sport

Breeding

For Children

Gift

Where will your pet be kept?

Where will your pet sleep at night?

How many hours a day will your pet be alone?

Where will your pet stay when you are out of town?

How much are you willing to spend per year to feed, vaccinate, and provide medical care for your pet?

How would you rate your general knowledge of the type of pet you are interested in adopting?

Your current veterinarian:

Please provide name + phone number.

What brand of heartworm prevention do you use?

Please list the pets currently in your household and the veterinarian who cares for them, if different from above:

Please provide the pet's name, breed, age, and if they are spayed/neutered:

Have you owned any other pets within the past FIVE years? If yes, please list them and circumstances why they are no longer with you?

Have you ever surrendered an animal to an animal shelter?

If yes, explain.

Number of adults in your household:

Please list number of adults + ages:

Number of children in your household:

Please list number of children + ages.

Is anyone in your household allergic to animals?

Please answer yes/no. If yes, please explain.

Do you live in a:

Do you:

If you are renting, what are the pet regulations (security deposits, size, and number limitations)?

What is your landlord's name and phone number?

Please provide landlord's name + phone number.

What is your home environment like?

When you travel, who will care for your pet?

FOR DOGS ONLY

Will you have time and patience to housebreak a dog, if necessary?

Is a doggie-door available?

Is your yard fenced?

If your yard is fenced, what is the height of the fence?

Do you have a swimming pool?

If you have a swimming pool, will your dog have access to it?

Please list two personal references, other than relatives.

Reference One Name:

First Name

Last Name

Reference One Contact:

(###)

###

####

Reference Two Name:

First Name

Last Name

Reference Two Contact:

(###)

###

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Agreement

By click 'I agree below', I am stating that the information I have provided is true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application as may be necessary to approve my application.

I agree