First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Which animal are you interested in
Choose an animal: ABRACADABRA BLISSFUL BLUEBERRY CRANBERRY DENIM GEORGIO ARMANI JIMMY CHOO MOLASSES NUTMEG ROUGE SUEDE TAFFETA

How many people reside in your household? *

What are the ages of the humans in the home?*

If you have children, have they been exposed to the type of pet you're applying for
Choose one: Yes No

Does anyone in your home have allergies to pets*
Choose one: Yes No

Who in the household will care for the pet*

Please list all pets in the household (species and age)

Where will the animal be kept when you are home*

Where will the animal be kept when you are not home*

How much time will the animal spend alone during the day*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal sleep*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

Why are you interested in adopting a pet at this time*

What traits are you looking for in a pet

For cats only: Are you planning to declaw
Choose one: Yes No

Describe how you will train the pet *

Have you ever given up a pet? If yes, please explain*

Have you applied with any other rescue*
Choose one: Yes No

How did you hear about us*

Veterinarian's Name and Phone Number (Please list the name on the account if different than applicant, and please notify vet of possible reference check)*

Is there any other information you feel is important to share with us?

Placing pets in the best possible home is our goal. We reserve the right to refuse applicants if we feel that the environment may not be suitable for the pet. We will review all applications and choose the one that we feel will best suit the needs of the individual animal. Once your application had been reviewed, we will contact you, and if accepted you will be invited back to finalize the adoption and pick up your new family member. By signing below you certify that the information on this application is true and you authorize Rescue 1 at a Time to contact your veterinarian for a reference. Please call your Vet and give us permission to speak with them. Enter your name and date *