Form

How did you hear about us?*

Did you read and do you fully understand our adoption process?*

Yes No I/We have some questions.

Which animal are you applying to adopt?*

Full Name*

First Name Last Name

Co-Applicant Full Name

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number (Primary)*

- Area Code Phone Number

Phone Number (Other)

- Area Code Phone Number

Applicants E-Mail:*

Co-Applicants E-Mail:

Applicant's Employer & Occupation:*

Co-Applicant's Employer & Occupation:

Would adopting this animal violate any local ordinances or laws?*

Yes No Unknown

If yes, what is the law/ordinance or what is the web address it is listed on?

Are you or is anybody in your household currently enlisted in the military?*

Yes No

Can this enlistment require you to move overseas or live in housing?*

Yes No

Do you Own or Rent*

Do you live in a:*

If other, please specify

If you reside in a rental unit or condo, do you have permission from the landlord or association to have a pet?*

Yes No N/A

Name/number of landlord or condo association:

Do you have a fenced yard?*

Yes No No yard

If yes, are the gates normally locked?

Yes No

If yes, what type of fence do you have?

If yes, does the fence enclose the entire yard?

Yes No

If yes, how high is the fence?

Do you have a pool?*

Yes No

If yes, is it fenced or covered?

Yes - fence Yes - cover Yes - fence & cover No fence or cover

How many adults live in your household?*

Number of children who live in the house full-time:*

Number of children who live in the house part-time:*

Ages of children:

Is anybody in your household allergic to animals?*

Yes No

If yes, who and what type of animal?

Is anyone home during the day?*

Yes No

If "yes", who?

As part of our adoption process we do home visits. Are you willing to allow us into your home for a home visit?*

Yes No

Have you ever given away an animal, returned an animal to a rescue or surrendered to an animal control*

Yes No

If yes, please explain:

Have you ever had a pet euthanized?*

Yes No

If yes, please explain:

If the occasion arises that you must move will all of your animals move with you?*

Yes No

If no, please explain

If you have other pets, please list their name(s) and their species/ breeds/ages:

Are they spayed/neutered, and up to date on vaccinations?

Yes No

If "no" please explain:

Do you currently have any animals with special medical needs?

Yes No

If yes, please describe

Why do you want to adopt a pet?*

If 'No" - please describe

If there is no fence, how will your dog have outside time?

Leashed Walks Outside Kennel/Dog Run Tie Out Electronic/Invisible Fence Trained to stay on the property Dog Yard

Where will this pet be kept during the day? (check all that apply)*

Inside Outside Crate Kennel

Where will this pet be kept at night? (check all that apply)*

Inside Outside Crate Kennel

When the family is not home, where will the dog/cat be kept? (check all that apply)*

Other (please explain):

On average, what is the longest period of time that you anticipate your pet will be left alone during the day?*

Who will be responsible for feeding and taking the dog outside?*

Who will be responsible for feeding the cat and changing the litter boxes*

Who will care for this pet when you go on vacation?*

Have you ever boarded your pets?

Yes No

If yes, where?

Are you willing to take responsibility for this pet for the next 10 to 15 years or longer?*

Considering the cost of veterinary care, food, boarding, grooming and licensing, etc. how much do you think it will cost to care for this animal each year?*

Does this expense seem prohibitive to you?*

Yes No

Are you willing to put in the time to housebreak and train a dog or litter box train a cat?*

Yes No

Do you understand that changing an animal’s environment may cause them to have accidents and training setbacks?*

Yes No

What circumstances would cause you to return this pet to the rescue?*

Are you prepared to cover boarding costs for Secondhand Snoots Rescue if you have to return your adopted animal to us?*

Yes No

Are you willing to take a formal obedience training class?*

If a behavioral problem arises, what steps will you take to work on it?*

What kind of behavior do you find unacceptable*

Please describe the temperament and activity level you are looking for in a dog. Check all that apply:

Veterinary Reference #1: Name of Veterinarian / Office:

Office Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Vet's Phone Number

- Area Code Phone Number

Name of Animals treated at this office:

Veterinary Reference #2: Name of Veterinarian / Office:

Office Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Vet's Phone Number

- Area Code Phone Number

Name of Animals treated at this office:

Reference 1-Full Name*

First Name Last Name

E-mail*

Phone Number*

- Area Code Phone Number

Reference 2 -Full Name*

First Name Last Name

E-mail*

Phone Number*

- Area Code Phone Number

Full Name

First Name Last Name

E-mail

Phone Number

- Area Code Phone Number

It is the policy of Secondhand Snoots Rescue Inc., NFP to perform a home visit prior to adoption.We will contact you after completing all of your reference checks to set one up.

We will set up a meet-and-sniff for your potential forever friend with you, your family members and any existing pets you may have before any adoption is finalized.

Secondhand Snoots Rescue Inc., NFP reserves the right to refuse any application / prospective adopter at any time during the process.

Secondhand Snoots Rescue Inc., NFP has little to no knowledge of the animal before they came into rescue; this includes information about their medical condition / background, disposition, behavior or training. Secondhand Snoots Rescue Inc., NFP makes no warranties with regard to the health or behavior of the animal and disclaims any liability for the animals medical condition, sickness, disease or behavior. All information that the rescue has regarding the animal will be fully disclosed at the time of the meet and sniff and again at the adoption contract review if the applicant is approved.

By giving your signature you attest that all information above is true and correct and that you give permission to Secondhand Snoots Rescue Inc., NFP to check your references which may require us to disclose information that you have provided in this application or that you have given via email or or other conversation to your references, including, but not limited to your landlord/condo association and veterinarian’s office.

You further acknowledge and understand that any omission of information and/or failure to answer all relevant questions and sign the application may result in the application being declined. You also understand the final adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal. Receipt of a completed adoption application does not obligate Secondhand Snoots Rescue Inc., NFP to finalize any adoption.

Date:

/ Month / Day Year

at

: Hour Minutes

Electronic Signature - Please type you full name*

Would you like to receive our email newsletter?*

Yes No

Secondhand Snoots Rescue, NFP Animal Adoption Questionnaire and Application

Household:

Animals:

Veterinary Reference

Personal References:

Reference #1:

Reference #2:

Additional Reference: (not required)