Rescue Row Adoption Application

Rescue Row Adoption Application
Rescue Row Inc. is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Rescue Row is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help Rescue Row and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption.
Applicant Information
Name/description of the dog you are interested in: *
Your full name: *
Age: *
Must be 25 or over to adopt
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number: *

Area Code Phone Number
E-mail: *
Employer: *
Position *
Do you have a spouse/co-applicant? *
Spouse/Co-Applicant Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Date of Birth *
Employer *
Position *
When will you be available to adopt a dog? *
What is the primary reason you want to adopt a dog? *
Under what circumstances would you not keep this dog? *
What is the ideal personality of the dog you'd like to adopt? Check all that apply.

Running Partner Lazy Social Butterfly Independent Cuddly Active Mellow Protector
Where will the dog stay at night? *
Where will the dog stay when you are not at home? *
Do you have a doggie door? *

Yes No Will get one
Average Number of hours per day the dog will be alone? *
How many weeks out of the year are you out of town?
When you are out of town, who will take care the dog?

Pet History
Do you currently have a dog? *

Yes No
Do you currently have cats or other animals? *

Yes No
Current Pet Information: *
If your pets are not spayed or neutered please explain:
Do you have any current pets with behavior issues? If so, what are the behavior issues?
Have you ever had to rehome a pet? *

Yes No
If yes, please explain. *
Have you recently had a a dog pass away? *

Yes No
If yes, please explain the circumstances *

Veterinary
Veterinary/Clinic Name: *
Veterinary/Clinic Phone Number *

Area Code Phone Number
Veterinary/Clinic Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
*By providing this information, you are giving permission to Rescue Row to inquire about your pet's medical history, including but not limited to: vaccination records, office visits, and test results.

Personal References
*Adoptions are based on best match, thus this application may not necessarily result in the adoption of the dog(s) listed above. Please know that Rescue Row strives to achieve the most successful match for both the dog and prospective family.
Is there anything else you would like us to know?
Signature
Potential Adopter Name: *

First Name Last Name
Potential Adopter Signature *

Clear
Date *

Month Day Year
Date
Potential Spouse/Partner Adopter Name:

First Name Last Name
Potential Spouse/Partner Adopter Signature:

Clear
Date

Month Day Year
Date
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Rescue Row Adoption Application

Applicant Information

Signature