Help Change Just One Pet's World.....Save1Pet

Save1Pet Adoption Questionnaire

Address:   City:
State:   Zip:


Your Date of Birth 

Please include area code with all phone numbers listed:

Home Phone 

Work Phone   

Your Cell Phone:       or   Spouse's Cell Phone  

What is the best time to reach you by phone and at which number?


How did you learn about Save1Pet?

Is this application for a currently available dog or cat?

If Yes, which one?  

Why are you interested in this pet?  

If No, please let us know what kind of pet you are looking for (breed type, size, male or female, approximate age): 


Do you rent or own?       House, Townhouse, Apartment?  

If renting, please supply the name and phone number of your landlord:  

How long have you lived at the current address?

Do you have  pool?

Please list below all people who live at this residence:

Name                                  Relation to You                      Age






Do all adults at the residence work full time? 

Are your other family members aware that you want adopt this animal? 

Is anyone in your family allergic to animals?       Is the animal going to be a gift for someone?


List below any pets you have owned within the past 5 years:
Name      Type/Breed   Age    

Spayed or




     On Heartworm


    Still own?

                       If other pets are not spayed or neutered, please explain why: 

How many times a day do you feed your animals? What brand(s)?

 Have you ever adopted a shelter or rescue animal before? If so, where?


For dog adoptions:

Do you have a fenced area on your property? 

If yes, please describe your fence (i.e. type, height) 

If not, how do you plan to have your dog relieve him/herself? 

What type of training will you pursue for your new dog?

How many hours each day do you plan to spend with your pet? 

Where will the new pet be kept when it is alone?

Where will your new pet sleep? 

What behaviors do you consider unacceptable in a pet?

How would you correct these behaviors?


Please list contact information for a veterinarian that you have used before.   Vet references are checked. 


Vet Name: 

Vet Phone Number (include area code):

Name under which your records will be listed: 

Please list two personal references, including phone number:

Name     Phone Number (include area code)

Name     Phone Number (include area code)

Please list the name of your employer and that of your spouse if applicable:

Name and Address of Your Employer:

Employer Name:

Employer Address:

Name and Address of Spouse's Employer (if applicable)

Employer Name:

Employer Address:

Does your job require that you move often?

If so, what will you do with the animal if you have to move?


What will you do with your pet when you travel on vacation?

The adoption donation is $95 - $200 for dogs and $75 - $100 for cats.  This cost is to cover the costs of spaying or neutering, worming, shots and other medical care.  All animals are spayed or neutered and given vaccinations prior to adoption.

Are these terms acceptable? 

If you adopt a pet from us, you are required to return the pet to us at your own expense if you can no longer keep the pet.

Are these terms acceptable? 

Please realize that dogs and cats need medical care through their lives, including yearly boosters, heartworm and flea/tick preventatives.  If you cannot afford the adoption donation, can you afford the appropriate veterinary care?  Please consider this before adopting.


I certify that I am eighteen (18) years of age or older,

and have read the above Adoption Application and will execute same promptly upon receipt of the animal. 

All medical records and pertinent information related to the animal will be provided to you upon receipt.

Signature (type name here if completing online):


Thank you for your interest in one of our homeless pets! 

Remember that many of our animals were pulled from less than ideal circumstances,

 and we want only the best for them in their new homes.

 Our adoption process is thorough and your answers will be reviewed.  Your vet and personal references will be contacted. 

We will contact you by phone or email address as quickly as we can,

but remember we are all volunteers, and deal with a high volume of calls and applications.

Please return this application by pressing the Submit button, or you may print it and mail it to:


P.O. Box 1335

Olive Branch, MS  38654