CPR ADOPTION APPLICATION
Name of the animal you are applying for:
Your name:
Spouse/Partner/Roommate:
Street address:
City/State/Zip
Home phone:
Work phone:
Mobile phone:
Email address:
Place of employment
Occupation:
Hours at work each day:
Age:
How did you hear about City Pet Rescue Adopt-A-Pet PetFinder.com City Pet Rescue website Referred by someone else Other
PLEASE COMPLETE ALL QUESTIONS
Why do you want a pet? Who will be responsible for this pet's care?
Is this your first experience with a pet?
Why do you want the breed you are applying for? Have you owned this breed/mix before? Where will this pet be dept during the day?
During the night?
How many hours at a time will this pet be left alone? Please list pets you currently own. Breed/sex/age. Are all pets spayed and/or neutered? Yes No Where are your current pets kept? Inside Outside
Please list pets (other than those listed above) that you owned in the past 10 years.
Type/breed/sex. Spayed/neutered? Kept outside or inside?
What happened to these pets?
Have you ever given an animal up for adoption or gotten rid of an animal?Yes No
If so, please explain the circumstances Who is your veterinarian? What is his/her phone number? Are all of the pets in your household up to date on rabies and viral vaccinations? Yes No Date of last vaccinations: Are you familiar with heartworm disease?
Are all the dogs in your household on heartworm preventative? What kind of heartworm preventative do you use? Not applicable Heartgard Interceptor Sentinel Revolution Other:
Date last heartworm preventative was given?
Do you agree to allow City Pet Rescue to call your veterinarian? Do you own or rent your current home? Rent Own
What type of home are your currently living in? Single family home Apartment Townhouse/condo Mobile home Other
If you rent, please provide the name and phone number of your landlord
Do you have written permission from your landlord to have pets? Yes No
Is a pet deposit required? and if so, how much per pet?
Is there a size/weight limit and/or limit to the number of pets you may own? and if so, what are those limits? How long have you lived at your current address? Do you plan to move within the next 12 months? Yes No If yes, what will you do with your pets?
Do you or your spouse travel frequently? and if yes, how often?
What will you do with your new pet when you need to travel?
How many people currently live in your household? Children? and their ages? Have your children had pets before? and if so, was it a positive experience?
Has the decision to adopt a pet been agreed upon by all adults in the household? Can you commit to care for the animal for its entire life?
Does anyone in your household have any know allergies to animals? Does your community have restrictions on the number of animals you are allowed to own?
Have you considered the level of financial commitment a pet requires and are you willing to accept the long-term financial responsibility for proper veterinary care for this animal? DOG ADOPTERS ONLY: Please select which best describes your yard and fencing situation: Do not have a yard Have a yard but no fence Small attached/fenced patio Yard with 4 foot high chain link fence Yard with 4 foot high wooden fence Yard with 6 foot high wooden fence Yard with 8 foot high wooden fence
Do you realize that you may have to housetrain this dog? Yes No Have you housetrained a dog before, and if so, what method did you use?
Are you familiar with leash and licensing laws in your community? Yes No
What will you do if your dog chews furniture or displays other destructive behavior?
Are you familiar with crate training? and would you use it?
Do you plan to take your dog to obedience training? Yes No CAT ADOPTERS ONLY:
Have you litter box trained cats before? Yes No Do you plan to declaw this cat? Yes No Are you aware of all the alternatives to declawing? Yes No If you have dogs, have they been exposed to cats before? Yes No
ALL OF THE INFORMATION I/ WE HAVE PROVIDED IN THIS APPLICATION IS TRUE AND CORRECT. IF ANY INFORMATION CHANGES, I/WE WILL NOTIFY CITY PET RESCUE PROMPTLY. (Entering your name below constitutes and electronic signature)
Signature
Date:
