New Beginnings
Animal Rescue
Pet Adoption
Application

First name:     Last name:
Address:   
City:              State: AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY     Zip:
Phone:              E-mail:

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1.) What pet are you interesting in adopting?   

2.) Why do you want a pet?
    

3.) Is this your first experience with a pet?      Yes   No

4.) What pets do you currently have in your household?
  a.) Name:      Age: 0 1 2 3 4 5 6 7 8 9 10 10+ years     Type: Cat Dog     Spayed/Neutered: Yes No     Kept Where: Indoors Outdoors
  b.) Name:      Age: 0 1 2 3 4 5 6 7 8 9 10 10+ years     Type: Cat Dog     Spayed/Neutered: Yes No     Kept Where: Indoors Outdoors
  c.) Name:      Age: 0 1 2 3 4 5 6 7 8 9 10 10+ years     Type: Cat Dog     Spayed/Neutered: Yes No     Kept Where: Indoors Outdoors

5.) List the pets you have owned in the last 5 years.
  a.) Type: Cat Dog   Spayed/Neutered: Yes No   Kept Where: Indoors Outdoors   Where is the pet now?
  b.) Type: Cat Dog   Spayed/Neutered: Yes No   Kept Where: Indoors Outdoors   Where is the pet now?
  c.) Type: Cat Dog   Spayed/Neutered: Yes No   Kept Where: Indoors Outdoors   Where is the pet now?

6.) Who is your Veterinarian?       Phone:

7.) Do you live in a (select)? House Apartment Condo Mobile Home Duplex Other

8.) Do you own or rent? Own Rent

9.) If you do rent, does your landlord allow pets? Yes No

10.) Who is your landlord?       Phone:

11.) How many people live in your home? 1 2 3 4 5 5+    Children: 0 1 2 3 4 5 5+    Age(s):

12.) Do all the adults in your home know that you plan to adopt a pet? Yes   No

13.) Does anyone in your home have any known allergies? Yes   No

14.) Who will be responsible for the care of this pet?

15.) Where will be this pet be kept during the day?    Night?

16.) How many hours a day will it spend alone without human companionship? 0 1 2 3 4 5 5+

17.) Where will it be kept when alone?

18.) Do you plan on spaying or neutering this pet? Yes   No

19.) Do you want a dog for (select all that apply)?
     (Press CTRL to click multiple)
     House Pet Guard Dog Watch Dog Companion Breeding Company for other pet Gift Other

20.) Do you have a fence? Yes   No    What type?

21.) How will you keep your pet confined to your property? (select all that apply)
     (Press CTRL to click multiple)
     House Fenced Yard Kennel Chain Runner Garage Porch/Patio Leash Electronic Fence

22.) What will you do if your pets shows destructive behavior, i.e. chewing furniture, potty accidents, nipping?
    

After submitting your application, click HERE.