Farm Animal Adoption Application

I agree that all statements in this application are made based on personal knowledge and are made for purposes of my application to adopt one or more animals from One Life at a Time Animal Rescue, Inc.

Name of animal(s) you are applying to adopt

I understand that One Life at a Time Animal Rescue Inc. is very concerned about the security and safety of my adopted animal and all the animals in its custody, as well as its ability to keep track of all animals rescued. I understand One Life at a Time Animal Rescue, Inc. will not share this information for any reasons not connected to the adoption program or applicable lawsuits.

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

*Email will be the primary method of communication from One Life at a Time Animal Rescue, Inc., so if you do not check email regularly, please tell us how to best get in touch with you.

Please list two references - people who know me (but are not related to me) and my animals

Please choose one of the below options

I care for my animals myself at my home, or rented facility.I board my animals

If you rent, or board your animals, please provide the name, address, and phone number below of your landlord/barn manager. Please also provide the amount of time you have been at this boarding or rental facility.

Height of fence

Type of fence

Number of years' experience with the type of animal you are looking to adopt

Please provide the name and phone number of the veterinarian(s) you use for your animals. If more than one, please list all veterinarians consulted in the last 5 years.

Please provide the name and phone number of the farrier/blacksmith you use for your animals (if applicable)

I understand a rescue representative may visit my home for a home inspection before my adoption application is approved.

I understand that if I am approved for adoption, I will also need to carefully read the “Adoption Agreement,” which is a separate document from this “Adoption Application.” The Adoption Agreement represents the legal contract between an adopter and One Life at a Time Animal Rescue, Inc. I understand that if I am approved to adopt an animal, I must review the Adoption Agreement before I can take my animal home. I further understand that I will be asked to agree to the terms of the Agreement and sign the Agreement before I can take my animal home.

I have read this Application in its entirety, and I agree that all statements contained in this document are made by me, and are truthful. I make this statement under penalty of perjury under the laws of the State of Pennsylvania.

Signature

Date

Time

:HourMinutesAM/PM Option