Adopt Application

Date

Pet Name

Person 1 Name *

Prefix First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Home Phone *

Area Code Phone Number

Cell Phone *

Area Code Phone Number

E-mail *

Person 2 Name

Prefix First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

E-mail

example@example.com

Please supply a list of all adult’s name and age who live in the house:

Do you have children?

Yes No

Child #1 Name

Age

Experience with Pets?

Yes No

Child #2 Name

Age

Experience with Pets?

Yes No

Child #3 Name

Age

Experience with Pets?

Yes No

Do you..

Own your home? Rent your home

Do you have authorization in your lease, rental, or homeowner's association contractto have indoor and outdoor pets?

Yes No

Landlord, Manager or HOA Contact:

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Email

example@example.com

Veterinary Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number

Area Code Phone Number

How many pets have you had in the past?

Have you ever had to give up one of your pets?

Yes No

If yes, please explain in detail

Do you have pets now?

Yes No

If yes, please provide Pet #1 's name

Species/Breed

Indoor?

Yes No

Sex

Male Female

Age

Vaccinated?

Yes No

Altered?

Yes No

Pet #2 's name

Species/Breed

Indoor?

Yes No

Sex

Male Female

Age

Vaccinated?

Yes No

Altered?

Yes No

Pet #3 's name

Species/Breed

Indoor?

Yes No

Sex

Male Female

Age

Vaccinated?

Yes No

Altered?

Yes No

Reference #1 Name

First Name Last Name

Phone Number

Area Code Phone Number

Relationship

Reference #2 Name

First Name Last Name

Phone Number

Area Code Phone Number

Relationship

Do you have a secure fenced backyard?

Yes No

How high is the fence?

How long will you be away from your pet on a daily basis?

What will you do with your pet while you are gone?

How will you exercise your pet?

Where will your new pet sleep at night?

What do you think makes this particular pet a good choice for you?

Have you had experience with this particular breed?

Are there any other comments you would like to add?

I certify that the above information is true and accurate to the best of my knowledge, and that I have willingly provided it to Casa de
Love Animal Rescue. I will notify Casa de Love Animal Rescue of any changes related to this information.

Signature of Applicant *

Clear

Date Signed *

Date

Print Name *

First Name Last Name

Signature of Co-Applicant

Clear

Date Signed

Date

Print Name

First Name Last Name

Signature of CLAR representative

Clear

Date Signed

Date

Print Name

First Name Last Name

Adoption Application