Pet Adoption Application Form
(Breed-Specific Rescue Shelter)
Applicant Information
First Name
Last Name
Address
City
State
Zip Code
Phone Number
Email
Household Information
Type of Residence
House
Apartment
Condo
Other
Do you own or rent?
Own
Rent
If renting, does landlord allow pets?
Yes
No
Is your yard fenced?
Yes
No
No yard
List all household members and ages
Any pet allergies in the home?
Yes
No
Current & Previous Pets
List current pets (name, age, species, breed)
List previous pets (where are they now?)
Adoption Preferences
Preferred Breed
Age Preference
Puppy/Kitten
Young
Adult
Senior
No preference
Gender Preference
Male
Female
No preference
Why are you interested in this breed?
References & Veterinarian
Personal Reference Name
Reference Contact
Current/Previous Veterinarian Name
Veterinarian Contact
Additional Information
Any questions or additional information