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Applicant's Name:
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Full Street Address, City, State, and Zip Code:
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County In Which You Live:
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Telephone Numbers -- Home:
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Work:
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Cell:
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Your Email Address:
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Are You Applying to Adopt a Pet, Temporarily Foster a Pet, or Volunteer in Another Way:
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Your Employer:
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Your Vet, Clinic Name, City, and Phone No. so We May Verify Your Pets Care:
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Your First Personal Reference (Not a Relative) Name and Home Phone No.:
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Your 2nd Personal Reference (Not a Relative) Name and Home Phone No.:
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Your 3rd Personal Reference (Not a Relative) Name and Home Phone No.:
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Please Click on the Appropriate Boxes to Signify That You Understand and Agree to the Following:
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I understand that completing an application does not mean that I will be able to adopt a pet
from the Creature Coalition.
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Yes
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I understand that a rescued pet has already suffered the loss of at least one family.
I will support the Creature Coalition's efforts to insure that the next home is a permanent one:
I will allow them to:
(1) Interview me and any references I provide.
(2) Discuss my current and previous pets with my veterinarian.
(3) Make a scheduled visit to my home to inspect fencing and other areas
where a pet will be kept.
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Yes
Yes
Yes
Yes
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I understand that the adoption donation will be used to offset expenses incurred by pets
in the Creature Coalition.
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Yes
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I understand that all rescued pets are to be spayed or neutered as agreed upon by
contract and never bred, either accidentally or intentionally.
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Yes
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I am able to afford annual veterinary care including vaccinations and prescribed medications
for a pet, as well as emergency care, if needed.
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Yes
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1) Please List All People Living in Your Home, Their Relationship to You, & Their Ages:
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2) Are Members of the Family At Home During the Day? If So, Who:
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Please Note That a 'Yes' Answer to Any of the Following Questions Does Not Necessarily
Disqualify You From Adopting a Pet.
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3) Does Anyone in Your Family Suffer from Asthma or Allergies or Otherwise Have a
Condition That May Limit Their Interaction with a New Pet? If So, Please Describe:
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4) Have You or Has Anyone In Your Household:
(a) Ever Been Convicted of a Felony?
(b) Ever Been Charged or Convicted of Animal Cruelty,
Neglect, or Abuse?
(c) Ever Surrendered An Animal In Lieu of Prosecution?
Please Explain Under Each Button If Any of These Have Occurred:
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Yes
No
Yes
No
Yes
No
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5) What Type of Home Do You Live In:
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House
Apt.
Town-house
Condo.
Mobile-home
Other (Explain Below):
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6) Do You Own or Rent Your Home:
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Own
Rent
Other (Explain Below):
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7) If You Rent, Does Your Rental Agreement Permit Pets? How Many? Please List Any
Size or Breed Restrictions:
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If Applicable, Please Provide Landlord Name and Phone Number:
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8) If You Own Your Home, Are There Any Zoning or Restrictive Covenants on Pet
Ownership (Including the Number of Pets Allowed)?
How Long Have You Lived At Your Current Address:
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9) If You Have a Yard, is it Fenced? If So, What Type, Material, and Height?
If Not Fenced, How Would You
Keep Your Pet in Your Yard? Does the Fenced Area Attach to or Surround the Area Where the
Pet Will Reside:
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10) Please Describe Fully Where the Pet Would Reside During the Day:
And At Night:
And When You Are Not Home:
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11) Please Describe Any Adult Pets You Have Owned:
Have You Ever Raised A Young Pet (puppy, kitten, other):
Where Are These Pets Now:
Where Did You Acquire These Pets:
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12) Why Have You Decided To Adopt A Rescued Pet:
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13) If You Have A Preference For Male or Female, Please Explain Why:
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14) Describe Any Specific Traits For Which You Are Looking In An Adopted Pet:
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15) Age Preference: Please Select One or More of the Following:
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Under 6 Mo.
Under 1 Year
1 to 2 Years
2 to 3 Years
4 to 5 Years
6 to 8 Years
over 8 Years
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16) What Expectations Do You Have For Your New Pet:
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17) Please Describe Your Experience with Dogs (obedience classes, showing, breeding, etc.):
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16) Where Would It Primarily Stay? Inside, Outside, or Both Equally:
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Inside
Outside
Both Equally
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19) Please List All Animals That You Presently Own, Their
Breed, Age, Gender, Medical Conditions, and Attitude:
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20) Are Your Pets Current On Vaccinations?
Rabies?
Spayed/Neutered?
On Monthly Heartworm Preventative?
If You Answered No To Any Question, Please Explain:
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Yes
No
Yes
No
Yes
No
Yes
No
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21) Please Explain If You Have Ever Bred Your Pet or Used Your Pet at Stud:
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22) Please Explain If You Have Re-homed, Lost, or Euthanized a Pet in the Past 2 Years:
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23) Have You Ever Applied to a Rescue, Shelter, or Humane Society to Adopt a Pet?
If So, What Were The Results?
Which Organization(s):
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Yes
No
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24) Do You Currently Own a Cat?
If So, Has Your Cat Ever Interacted with Dogs?
Please Describe the Interaction:
Is Your Cat Indoors Only, Outdoors Only, or Both?
Is Your Cat De-Clawed?
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Yes
No
Yes
No
Indoors Only
Outdoors Only
Both In and Out
Not Declawed
Declawed
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25) Are You Interested In A Particular Pet? If So, Please List Pet's Name and Breed or Description:
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26) Please Give Directions to Your Home From a Major Highway:
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IMPORTANT!
Your pressing the SUBMIT button to forward your application to us
authorizes the Creature Coalition to contact your references
and verify all information provided to us on this application. Please realize that any inaccurate
or incomplete information can be grounds for our refusal to adopt to you.
Should your application be approved, this document will be part of your adoption contract.
Misrepresentation in this application discovered after adoption from the Creature Coalition
could result in your immediate forfeiture of the pet.
You also agree to sign a print-out of this form in writing before receiving a pet.
Please click SUBMIT now. It will email your application to us, then return you to our homepage.
Please call us at 919-542-7585 or email us at resqdogs at mindspring.com if you
haven't heard from us within 72 hours. Please check your SPAM folder first!
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