Adoption Application

Which cat(s) or dog(s) are you interested in: *

How did you find out about our rescue? *

Name *

First Name Last Name

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

Your home is: *

House Apartment Condo/Townhouse Other

If you are renting, please provide landlord name and contact info:

Who will be the main caregiver of the cat/dog?

Are all parties of the household on board and willing to help with the care of a new addition? *

Yes No

If adopting a kitten/cat, will you be declawing? *

How would you handle destructive behavior? (cat -scratching or urinating out of box or dog - accidents in the house, excessive barking) *

Check all that apply. Who do you live with? *

Alone Spouse/Partner Roommates Parents Children

Please list name, relationship and ages of all people who live in the household *

Describe the kinds of personal situations where you may have to return your adopted cat or dog, e.g. job loss, children, move, marital change, etc *

Have you or anyone living at the home been charged or convicted of an animal-related crime? *

Yes No

If yes, please explain

Cat/Dog Living Situation and Lifestyle - where will the pet live? *

Inside Outside Combination

If adopting a dog, what type of fencing do you have? *

Privacy fence/Physical fencing Invisible Fence No fence

Home setting: *

Urban Suburban Rural

Describe all pets you have owned in the last FIVE years:

	Name	Type (cat/dog/?)	Breed (if dog)	Age	Sex	Spayed/Neutered	On heartworm preventative?	Indoor/Outdoor	Where is pet now?	If deceased, please explain
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6

Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control center? *

Yes No

If yes, please explain

How many hours per day will your pet be alone? *

Do you understand this is a 10-20 year commitment, the lifetime of your pet? *

What kind of veterinary care do you plan to provide? *

If administering heartworm preventative, please indicate where you purchase from if not from the vet practice listed. *Proof of purchase is required.

Vet References

Name of Practice:

Name of Vet:

Phone # of Vet:

Name and phone # vet records are listed under:

Any other info that would be helpful for us to know

Are you prepared to spend $500 or more in the event of an emergency vet visit? *

YES NO

Pets can live many years. If your pets were to outlive you, what would happen to them? *

I have read the above information carefully and have filled out this application truthfully. I understand that omission of information and/or failure to answer all questions and/or sign the application can result in this application being denied.

I understand that my name and date below represent my signature for the purpose of this application

NOTE: Many vets now require owner's permission to disclose vet history. Please contact your vet to tell them a representative from Vintage Racers for Rescues will be calling for this history so that the processing of your application will not be delayed.

Your full name: *

Date *

Date