New Beginnings Animal Rescue

New Beginnings Animal Rescue

Adoption Application
Awesome! You have decided to adopt a new pet to your family and you are ready to submit an Adoption Application.

Before doing so, please take a moment to be sure you are applying to New Beginnings Animal Rescue located in Olive Branch, MS. Please note, there are rescues all over the world with similar names as ours. New Beginnings Animal Rescue (www.newbeginningsanimalrescue.net) rescues in the Mid-South area, which includes Mississippi, Arkansas and Tennessee. We also transport many of our dogs to New England area (New York, New Hampshire, New Jersey and Connecticut).
Have you verified you are applying to adopt a pet from New Beginnings Animal Rescue based in Olive Branch, MS? *
Thank you!
Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.

The following questionnaire has been designed to aid both you and the adoption group in deciding if you and/or your family are adequately prepared to assume the responsibility of pet ownership. Please be sure to ANSWER ALL QUESTIONS. If a question does not apply type N/A.
Today's Date

Month Day Year
Name of Animal interested in Adopting
Dog or Cat *
In order to be considered as an adopter you must:

* Be 21 years of age or older

* Have identification showing your present address

* Have the knowledge and consent of your landlord

* Be able and willing to provide a loving, safe and peaceful environment for this pet

* Be financially stable and willing to provide any necessary medical care
ADOPTER'S GENERAL INFORMATION
Primary Adopter Full Name

First Name Last Name
Primary Adopter Age *
Ages
Primary Cell Phone *
Secondary Adopter Full Name

First Name Last Name
Secondary Adopter Age
Ages
Secondary Cell Phone
Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code
E-mail *
Primary Adopter Employer
Primary Adopter Employer
Primary Adopter Occupation *
Primary Adopter Occupation
Primary Adopter Work Phone
Primary Adopter Work Phone
Secondary Adopter Employer
Secondary Adopter Employer
Secondary Adopter Occupation
Secondary Adopter Occupation
Secondary Adopter Work Phone
Secondary Adopter Work Phone
Best Time to be Contacted *
Best Time to be Contacted
PET INFORMATION
Do you currently own pets? *
If you answered Yes, list current pets names, breeds, sex, pet's ages:
If you don't have pets now, please list past pets you have owned in the past five years, indicating name, breed, sex, pet's age, and what happened to them. *
VETERINARIAN INFORMATION
Name of Veterinarian
Please list your veterinarian. NBAR will contact them to verify your current pets are up to date on shots and altered; this is a requirement for new pet adoptions. Please call their office(s) to authorize release of information to New Beginnings Animal Rescue. If you are planning to utilize another vet but are not currently a client, please note that information.
Phone Number of Veterinarian
Address of Veterinarian

Street Address

Street Address Line 2

City State

Postal / Zip Code
Please list names your pets records are under.
If you currently do not have a veterinarian please list who you are planning on using
REFERENCES
Please provide two non-related references and their relationship to you. Please advise them a NBAR volunteer will be contacting them so they can expect our call/email:
Name Personal Reference #1 *
Name Personal Reference #1:
Relationship of Referencce #1
Phone Number Ref 1 *
Email of Personal Ref 1
Name Personal Reference #2 *
Name Personal Reference #2
Relationship of Referencce #2
Phone Number Ref 2 *
Email of Personal Ref 2
ADDITIONAL INFORMATION
Why do you want to adopt at this time? *

Companion for you/family/another pet Guard Dog Gift Other
If adopting a CAT, do you plan to declaw? *

YES NO n/a adopting a dog
Do you have a fenced yard? *

YES NO
Fence Height

4 ft 6 ft 8 ft none
Type of Fence?
Type of Fence
Do you have a...
Is anyone home during the day? *

YES NO
How many hours will the pet be left alone? *
How many hours will the dog be left alone?
Where will your new pet stay at night? *
Where will your new pet stay at night?
If adopting a CAT, where will the litter box go? *
Where will litter box go?
Do you travel?
Where do your pets stay if and when you travel?
PROPERTY/HOUSEHOLD INFORMATION
Please list the name, age and relationship to yourself of each person currently living in your house (ex- Mary, spouse 35) *
Occupancy
Own/Rent/Live with parent
Type of Home *
Type of Home
How long at current address? *
How long at address?
Do you plan to move within the next 6-12 months? *
Do you plan to move within the next 6-12 months?
Are you willing to have a NBAR volunter do a home visit? *
Are you willing to have a NBAR volunteer do a home visit?
Name of Landlord
Name of Landlord
Landlord's Phone
Landlord's Phone
If you rent are pets allowed? Please call to verify and to notify your landlord we will be calling to verify all information. Thank you!

Yes No
Are there any pet restrictions? *
Are there any pet restrictions?
Pet Deposit? *

Yes No
How much is your pet deposit per pet?
Is there an increase in your monthly rent?

Yes No
Do all parties in the household want a pet? *
Do all parties in the household want a new pet?
Which of the following situations would lead you to give away your pets?

Moving to another state Having a baby Ruins the furniture Too expensive Getting a divorce or married Grew too big Would not give up for any reason Fleas or sheds too much Finished school/moving back home Children will no longer care for pet Allergies Found a new "no pet" rental Digging/Chewing Other
What would you do with your pet if you could not keep it for the reasons stated above? *
Have you ever surrendered a pet to a shelter/pound? *
If yes, why?
How do you discipline a pet?: *
How much do you believe the annual expenses for this animal will be?: *
Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring for pet? If yes, please provide name, address, phone number and relation.
Do you have the time to provide adequate love and attention to a pet?: *
Do you agree to provide healthcare for your pet if it gets sick? *
Do you agree to keep a dog on heart worm and flea prevention?: *
Has anyone in your household ever been accused or convicted of animal abuse, cruelty or neglect?: *
Do you agree you will provide adequate food, water, and annual vaccinations for this pet?: *
Do you agree that all the information you have given is true and accurate?: *
Is there anything else you would like to tell us that you think would be important when considering your application?
PLEASE READ AND SIGN BELOW:

Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit their individual needs. Please ask for clarification if you have any questions.
Primary Adopter *
Primary Adopter
Secondary Adopter
Secondary Adopter
Thank you for applying to adopt a pet from New Beginnings Animal Rescue! Please allow 48-72 hours to process your application.
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