This adoption form must be completed in full to begin the adoption process with ALMOST HOME RESCUE. Please be as truthful and forthcoming as possible for us to help you determine whether a good match is likely. Each item of information on the application is important, and any omitted elements will be requested before the application can be processed. (This may also cause unwanted delays.)If we do not receive a response for requested information, the application will be denied. All information is verified during application processing to ensure the safety and future well-being of every dog that is adopted. Our goal is to work closely with each potential adopter to ensure the best possible match based on compatibility of personality, environment, and lifestyle. Please help us help you!Email Address Your Name Your Age Street Address City State Zip Code Home phone Cell phone Names and ages of all other people in the house and relationship to you: Name Relationship Age Name Relationship Age Name Relationship Age Name Relationship Age Name Relationship Age Name Relationship Age Where do you work? Work Phone Where does your spouse work? Is everyone in the family in agreement to adopting a new dog? Yes No Who is home during the day? Are there other small children that visit your family, such as grandchildren, etc.? Name Relationship Age Name Relationship Age Name Relationship Age Which dog are you interested in adopting? Breed Have you ever owned a Jack Russell Terrier before? Yes No Do you currently have pets? Yes No Please list current pets: Name Breed Age Male Female Spayed or neutered? Yes No How did you acquire pet? Name Breed Age Male Female Spayed or neutered? Yes No How did you acquire pet? Name Breed Age Male Female Spayed or neutered? Yes No How did you acquire pet? Name Breed Age Male Female Spayed or neutered? Yes No How did you acquire pet? Do you keep your pets outdoors or indoors? Indoors Outdoors Do you keep your pets on heartworm preventative? Yes No Are your pets up to date on their vaccines? Yes No Have you owned pets in the past? Yes No Name Breed Age Where did you get this dog? How long was the dog with you? What happened to this pet? (please tell us briefly in exact terms) Name Breed Age Where did you get this dog? How long was the dog with you? What happened to this pet? (please tell us briefly in exact terms) Name Breed Age Where did you get this dog? How long was the dog with you? What happened to this pet? (please tell us briefly in exact terms) Have you ever surrendered a pet to a shelter? Yes No If 'yes', what were the circumstances? How many hours a day would the dog be alone? 0-2 hours 2-4 hours 4-6 hours 6 or more hours Do you have a fence? Yes No If yes, what type? Wood Chain Link What height? What is the size of your fenced area? Does your dog have free access to the fenced yard through a DOGGIE DOOR? Yes No Are you willing to crate train your dog? Yes No Where will the dog sleep? Do you own or rent? Own Rent How long have you lived there? Type of Residence: If you rent, please give your landlord's name and phone number: Landlord Name Landlord Phone **Please list your current Vet and the Vet you have used for your dogs in the past. If this is omitted your application will be delayed in processing.** Current Vet name Current Vet phone number Pets on account at current Vet's office Previous Vet name Previous Vet phone number Pets on account at previous Vet's office Please give us two personal references to contact: Name Phone Name Phone Anything else you want to tell us? |