Adoption Application

Completion of an Adoption Application is required before the adoption is complete.
*Please fill in all required fields before submitting.

Name *
Name
Address
Address
Home Phone
Home Phone
Work Phone
Work Phone
Cell Phone
Cell Phone
Your Pet History
Would this be your first pet?
(include age, sex and breed)
Have they been spayed/neutered?
Are they current on vaccinations?
Could we contact your veterinarian?
If yes, please provide their name:
If yes, please provide their name:
...and phone number:
...and phone number:
Have you ever put a pet into a shelter?
If you considered a dog, was your last dog obedience trained?
Some information about your family
Does any member of your family have an allergy to pets?
Is someone home during the day?
If you rent, may we contact your landlord?
Please provide the landlord's name:
Please provide the landlord's name:
...and phone number:
...and phone number:
If you are adopting a cat:
$
If you are adopting a dog:
Do you have a completely fenced yard?
(i.e. privacy, invisible fence)
Does it have a gate?
Do you have a dog door?
Are there times when the dog will be tied up?
Are there stairs that lead to your home?
Will the dog spend any time in the garage?
Do you have a pool?
Is there a fence around the pool?
Will you be willing to exercise the dog on a regular basis?
$
Pet Care
Will you keep the pet up-to-date on vaccination/heartworm prevention?
If you move, will you take the pet with you?
Are you willing to let an ACT V Rescue & Rehabilitation representative come to see where the pet will be living?
Are you willing to take responsibility for this pet for the next ten to fifteen years?
Please provide 3 personal references:
Name
Name
Reference 1
Phone
Phone
Name
Name
Reference 2
Phone
Phone
Name
Name
Reference 3
Phone
Phone