Adoption & Foster Application

1
Adoptive Animal's Name
2
Date
Date
Month
Day
Year
3
Is this a Foster or Volunteer application?
4
Your Name
First Name
Last Name
5
Email
example@example.com
6
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Daytime Phone Number
Area Code
Phone Number
8
Cell Phone Number
Area Code
Phone Number
9
Profession/Employer
10
Years at current address
11
Your current home is
owned
rented
other
Type option 4
12
If other:
13
Your current home is a:
House
Apartment
Condo
Townhouse
Other
14
If other:
15
If a rental, does your lease allow pets:
Yes
No
Type option 3
Type option 4
16
If yes, property management name and phone number:
17
Is your backyard completely fenced?
Yes
No
Type option 3
Type option 4
18
If yes, what type of fence?
19
If yes, what is the height of the fence?
20
If yes, are the gates kept locked?
yes
no
Type option 3
Type option 4
21
Do you have a pool?
yes
no
Type option 3
Type option 4
22
If yes, type of pool?
23
Is your pool fenced?
yes
no
Type option 3
Type option 4
24
Are you at least 21 years old?
yes
no
Type option 3
Type option 4
25
Household Member 1 - Name, relationship and age:
26
Household Member 2 - Name, relationship and age:
27
Household Member 3 - Name, relationship and age:
28
Household Member 4 - Name, relationship and age:
29
Household Member 5 - Name, relationship and age:
30
Any additional household members:
31
Do any members of the household have allergies or asthma:
yes
no
Type option 3
Type option 4
32
If yes, details:
33
Do you have regular visitors (human or animal)?
yes
no
Type option 3
Type option 4
34
If yes, please explain:
35
How many hours on average will your new pet be left alone on weekdays:
36
How many hours on average will your new pet be left alone on weekends:
37
Do you currently own a pet?
yes
no
Type option 3
Type option 4
38
If yes, type of pet, breed, age, name and how long owned:
39
Have you ever had to give up a pet?
yes
no
Type option 3
Type option 4
40
If yes, please explain:
41
Veterinary you currently use for your pets, name, address and phone number and the client name the pet is listed under:
42
Veterinary you plan to use for your new pet, address and phone number:
43
How frequently do/did your pets go to the vet?
44
How frequently do you plan to take your new pet to the vet?
45
Please provide brief significant medical history of current or previous pets:
46
Are/were your pets on flea/tick preventative?
yes
no
Type option 3
Type option 4
47
If yes, what type?
48
If no, why?
49
Are/were your pets on heartworm preventative?
yes
no
Type option 3
Type option 4
50
If yes, what kind:
51
If no, why?
52
Preventatives you plan to use on your new pet:
53
Why are you interested in adoption?
54
I am interested in:
Puppy
Young dog
Middle aged dog
Senior
55
I am interested in:
High energy dog
Medium energy dog
Low energy dog
Type option 4
56
Please explain why you are interested in this particular pet?
57
Who will be responsible for feeding your new pet?
58
Who will be responsible for exercising/playing with your new pet?
59
Who will be responsible for your pet's expenses?
60
Where will your pet stay when you are out of the house?
61
Where will your pet stay when you are at home?
62
Where will your pet stay overnight?
63
What will you do with your pet while you are on vacation?
64
Do you plan to crate train your pet?
yes
no
Type option 3
Type option 4
65
How do you plan to handle chewing, destruction or any other behavioral issues?
66
We may require certain dogs to attend training classes. Is this acceptable?
yes
no
Type option 3
Type option 4
67
Are you planning to move in the near future:
yes
no
Type option 3
Type option 4
68
If you had to move, what would you do with your pet?
69
Please provide 2 personal references, names & phone numbers:
70
May an authorized representative of Wichita Pug Rescue visit and inspect your home?
yes
no
Type option 3
Type option 4
71
I authorize a representative of Wichita Pug Rescue to contact the veterinarian office(s) named above to confirm the medical records/histories of my pets. (To affirm, please enter your initials or name below):
72
I UNDERSTAND THAT IF I AM UNABLE TO KEEP A PET ADOPTED FROM WICHITA PUG RESCUE, I WILL RETURN THE PET TO WICHITA PUG RESCUE (To affirm, please enter your initials or name below):
73
I understand that if I am unable to afford proper vet care for a pet adopted from Wichita Pug Rescue, I will contact Wichita Pug Rescue for guidance and assistance (To affirm, please enter your initials or name below):
74
How did you hear about Wichita Pug Rescue?
75
Comments:
Should be Empty: