Adoption Application Form

Thank you for considering the adoption of one of the Beacon Family. The decision to adopt a pet is an important one, therefore the adoption committee must be able to contact all personal and veterinary references before making an informed decision and contacting you. This may take some time, especially if it is difficult to contact your references. All of our pets are spayed/neutered BEFORE they leave the premises; if the one you are choosing is not already altered, an appointment will be made, and the pet will be altered prior to you picking it up. We want to insure that our pets go to a good home; where they will not only be loved, but given the proper medical treatment, and training.

Before you begin this application, please understand that we do not guarantee the health, or temperament of the animal, or whether the animal is housebroken or has training.

In order to adopt, you will need the following:

1.) You must have a veterinarian reference. If you do not, you must provide a second personal reference, and by submitting the application, you consent to a home visit by one of our volunteers.

2.) You must have 2 forms of ID.

3.) You must provide proof of home ownership. If you do not own your home, a copy of a lease showing that you are allowed to have a pet is required.

4.) You must give the name and phone number of one personal reference - two if you do not have a veterinarian.

5.) You must provide proof of regular veterinary care including but not limited to annual vaccinations and use of heartworm, flea, and tick preventatives.

Beacon Animal Rescue reserves the right to refuse any application-and will return any deposits made on the animal-if the application is not approved. There may be several applications received on one pet. Each application will be reviewed, and the pet will be placed in the home that we feel will be the most compatible. Our pets are always welcome back in the event that you cannot keep them anymore; however, there are no refunds on adoption fees.

It is important that you understand the above information, before submitting this application.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE ADOPTION INFORMATION AND I AM 21 YEARS OF AGE OR OLDER. *

Yes

Name of Pet(s) you are interested in adopting *

Is this a dog or cat? *

Dog Cat

Have you met this pet? *

Yes No

If yes, when?

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code Country

Home Phone Number *

Cell Phone Number

E-mail *

Confirmation Email

Employment Status *

Employed Retired Attending School Homemaker

Employer

Employer Address

Street Address

Street Address Line 2

City State

Postal / Zip Code

Business Phone

Are there any children at home or do you have children who visit /stay at your home on a regular basis? *

Yes No

If yes, how old are the children?

Are any members of your household allergic to animals? *

Yes No

Are there other pets in your home? *

Yes No

If yes, what kind? (i.e. dog, cat, other)

Are your pets spayed or neutered? *

Yes No NA (select if there are no other animals are in the home)

Are your pets current on vaccinations? *

Yes No NA (select if there are no other animals are in the home)

Are your pets current on heartworm prevention? *

Yes No NA (select if there are no other animals are in the home)

How many hours a day will your new pet be left alone? *

Where will your new pet be kept primarily? *

Inside Outside

Have you owned pets in the past? *

Yes No

If yes, please list the name, breed and age of all pets you have owned within the past 3 years.

Do you still own any of the above? If not, please explain.

Do you have a fenced in yard? *

Yes No

If yes, list fence height & approximate yard size (sq. ft.)?

Do you own or rent your residence? *

Own Rent

If you rent, please list your landlord's name and phone number. *

How far from the road/traffic is your home located? *

Is the volume of traffic: *

Light Moderate Heavy

Have you ever had an adoption application rejected for an animal from a rescue/shelter/pet shop? *

Yes No

If yes, why?

Why do you want to adopt an animal? *

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

If adopting a cat, will you declaw the cat? *

Yes No N/A (Select if applying for a DOG)

Are you familiar with your local animal control laws? *

Yes No

Do you have any medical conditions preventing you from handling an animal? *

Yes No

Vet's name: *

Vet's Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Vet's Phone Number: *

Is your name listed as the "Primary Owner" with this Vet's office?

Yes No

If not, whose name is listed as the Primary Owner?

Reference Name: *

First Name Last Name

Reference Phone Number: *

Have you ever adopted from Beacon Animal Rescue? *

Yes No

If yes, When?

Reference Name: *

First Name Last Name

Reference Phone Number: *

Is this pet going to be a: *

Family Pet Child's Pet Watchdog Companion for another pet

Why have you chosen this specific pet for adoption? *

Where do you plan to keep your dog or cat while you're at work or away from the house? *

For what problems do you feel you might need some assistance or information? *

Would you like to be included on our mailing list? *

Yes No

Volunteer at Beacon Animal Rescue? *

Yes No

I HEREBY CERTIFY THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE. *

Yes

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PLEASE CONTACT THE RESCUE
IN 1 - 2 DAYS TO FOLLOW-UP
ON YOUR APPLICATION!

Phone: (609) 390-7946

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For Shelter Use Only

DL ________________________

(Driver's Licence)

ID _________________________

(Proof of home ownership; i.e., tax bill, etc.)

(updated-1/13/15)

Pre-Adoption Questionnaire

HOUSEHOLD INFORMATION

VETERINARIAN REFERENCE

PERSONAL REFERENCE 1

PERSONAL REFERENCE 2

ABOUT THIS PET