Bright Futures Pet Adoption and Rescue

Time Owned

Where Kept

Please tell us where this pet is now or anything else you want us to know about them.

Personal Information

First Name	Last Name	Age	E-Mail

Address	City	State	Zip

Employer	Spouse's Employer

Cell Phone	Home Phone

Does everyone in your household know you are planning to adopt? Yes No

Briefly tell us about the other adults in your household

Name	Relationship to you	Age
Name	Relationship to you	Age
Name	Relationship to you	Age

Briefly tell us about any children in your household

Name	Relationship to you	Age
Name	Relationship to you	Age
Name	Relationship to you	Age

Please list 2 references not related to you or living in the same household.

Name	Address

Phone Number	Relationship

Name	Address

Phone Number	Relationship

Residential Information

Are you willing to let a representative of Bright Futures visit your home? Yes No

Do you live in a

house

apartment

other

How long have you lived at this residence?

Are you planning on moving in the next 6 months? Yes No

Is your yard fenced? Yes No
If yes please describe your fence?

Do you

own

rent

lease

live with family

live with friends

If you're renting your residence please answer the following:

Landlord's name

Phone number

Your new pet

Which animal are you interested in adopting ?

Who will be the primary care giver?

Why do you want to adopt a new family member?

How will you deal with destructive behavior like chewing, digging, or jumping?

Routine health care can cost up to $300.00 a year and emergencies are often over $1,000. Are you willing to provide this care if necessary ? Yes No

Where will your new pet be kept:
At night		If you move
During the day		When on vacation

On an average day how long will the pet be left alone?
How many days a week?

Current or Previous Pets

Please tell us about your current pets and pets you have had in the past.

Please use the space below to tell us about any other pets you have or have had.

Please use the space below to list any comments or questions you may have.

Veterinarian used for current and past pets:		Phone #
May we contact them to ask about your current pets? Yes No

By clicking submit below I understand that I am entering into a contract with Bright Futures Pet Adoption & Rescue, Inc.. I certify that the above information is true and I recognize that any misrepresentation of facts may result in denial of adoption. I authorize investigation of all statements in this application and understand that veterinarians, other humane societies or rescue organizations, landlords, etc. may be contacted.