Moonracer Adoption Application

What animal are you interested in adopting? *

Your name *

First & Last Name

Your Address *

Street Address

Street Address Line 2

City State

Zip Code

Your Email *

Your Phone Number *

Area Code Phone Number

Phone Type *

Cell Home Work

Employer *

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Names and ages of all residents of your home (adults/children) *

Please list any pets currently living in your home, and if they are vaccinated and altered. *

Vet reference (please call your vet and give notice that we will call. If you have not been to a vet before, please register with one soon.) *

Vet name, address & phone number

Will you allow Moonracer to visit your home prior to approving your adoption application? *

Yes No

Are you planning to move in the near future? *

Yes No

If moving soon, to what city/state?

When will you be ready to adopt this animal? *

Today This weekend Within a week Within a month Not ready yet, just researching

Is anyone in your home allergic to the animal you're planning to adopt? *

Yes No Yes, but it is tolerable for them and they are OK with it.

Are you familiar with the breed? *

Yes No

You live in a: *

Single Family Home Duplex/Twin Condo/Townhome Trailer Apartment

Do you rent or own this property? *

Rent Own

Landlord *

Landlord Phone # *

Area Code Phone Number

If you rent, you must give Moonracer No Kill Animal Rescue a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have this type of animal there and show any restrictions.

How long at this address: *

Previous Address (if less than 2 years)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Do you have a yard? *

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)

Have you discussed this adoption with all members of your household? *

Yes No Yes, adults have discussed. Kids don't know yet.

If applicable, will your children be taught how to play gently and kindly with this animal? *

Yes No No children

Have you ever had to give up a pet? *

Yes No

If yes, explain

Vet bills can be expensive. How do you plan on paying them? (IE: Pet health insurance) *

Reference (Other than a family member) *

Do you have any additional comments, questions or concerns?

By checking the box below, you understand the terms of this form and adoptee. You hereby agree that you will not use this animal in any sort of fighting or cruelty. You will love and care for this animal for the rest of its life, and you are ready to commit to that. You also agree, that if for any circumstances you can no longer provide love and care for this animal, you will contact Moonracer No Kill Animal Rescue and explain your situation before rehoming or taking the animal to a shelter.

I understand the above, and have tried to the best of my knowledge to make sure all information is correct.

Adopter's Signature *

Signature date *

Thank you for taking the time to submit this form. After you click the Submit button, you will recieve a confirmation email. Thank you!