Address A value is required.
City A value is required. State/Prov A value is required.Zipcode
Occupation:
Home Phone A value is required. Work Phone
Email A value is required.Invalid format.
Are you at least 21 years of age? Yes No
Do you own or rent your home? Own Rent How long have you been at your current residence?
Will you be moving soon? Yes No
If you rent, can you verify that you can have a pet? Yes No
How long will the pet spend alone each day?
Is this pet a gift? Yes No
Will you assume full financial responsibility for your pet? Yes No
Will you take your pet to the vet within 14 days of adoptionand regularly thereafter? Yes No
Do you object to our visiting your home or calling you in the future? Yes No
Why do you want a pet?
What specific traits are you looking for in a pet? (ie. temperment, energy level)
List your past pets in the last 10 years: Note: If you have more than three, please list them in the Additional Comments section below.
Breeds
Cats Names
If not still with you, what has happened to them?
Do you presently own any pets? Note: If you have more than three, please list them in the Additional Comments section below.
Dogs Names
Are your pets spayed and neutered? Yes No
Are all your pets current on their vaccinations? Yes No
Are all your pets current on their heartworm preventative? Yes No
Your current and/or previous veterinarian(s)?
Owners name your pet(s) will be listed under(ex. maiden name):
Veterinarian Phone Number 1: Phone Number 2:
Note: We will be doing a vet check, so you must provide a name and number for current and/or past pets. Please contact your vet to give them permission to discuss your pet's history with Rose's Rescue.
Omitting information on the application will slow down the processing of the application. If you need to provide additional information, please use the comment section at the bottom of the application.
Are your pets kept inside or outside? Inside Outside
Where will your pet stay when you are not at home (at work etc.)?
Where will your new pet sleep?
Who will care for your pet if you are on vacation?
Does anyone in your home have an allergy to animals? Yes No
If yes: Dog Cat Other
List the ages of all people in your home:
If you have children, have they been around pets? Yes No
What will you do if your new pet claws or chews your furniture or shows signs of other destructive behavior?
What animal behavior would you be unwilling to work with?
Cat Application
If adopting a cat, will you have it declawed? Yes No
Will this be an inside or outside cat? Inside Outside
Dog Application
If adopting a dog, will you keep a collar with ID tags on your pet at all times? Yes No
Do you have a fenced yard? Yes No
If not how will you confine him/her while outside?
Are you willing and able to leash walk your dog? Yes No
Will this be an inside or outside dog? Inside Outside
Additional Comments:
Before you submit this application, please ask yourself if you are really ready to make a life long commitment. These animals have already been dumped at least once, and we do not want them to need rescuing again. So PLEASE make sure you are ready to make this committment to them before applying. By clicking on the submit button I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND THAT ANY FALSE INFORMATION MAY RESULT IN THE NULLIFICATION OF THIS ADOPTION
