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Adoption Application

Adoption Application

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Published by Carol Borrelli
Adoption application
Adoption application

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Published by: Carol Borrelli on Jan 15, 2013
Copyright:Attribution Non-commercial

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01/15/2013

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CINAGRO FARM RESCUE SERVICES, INC.P.O. Box 895661Leesburg, FL 34789 AdvocateForWhiskers@gmail.com 
 
www.CinagroFarm.com352.978.3724888.886.1640 [fax]
ADOPTION APPLICATION
NAME:_____________________________________________ ADDRESS___________________________________________CITY:______________________STATE:__________ZIP:______________PHONE: HOME:__________________CELL:______________________E-MAIL ADDRESS:______________________________________________________Driver’s License number:_______________________________________
Do you work? Where?__________________________________Phone numbers:________________Do you own or rent?__________________________ Landlord’s name and phone:____________________Home type [circle one]: Single family Mobile Apartment CondoCurrent Veterinarian:___________________________ Phone number:_________________________May we call your vet for a reference?_____________List all current pets in the household:___________________________________________________How many dogs have you owned?______________________________What happened to them?_____________________________________How many hours are you away from the home during the day?_______________________Where will the pet be kept when you are away from the home?_________________at night?______________Will the dog be an inside dog or an outside dog?__________________________Activity level in the home [circle one]: Grand Central Station Some activity Zen-garden sereneLocal personal references: name and phone numbers.1.2.
 
CINAGRO FARM RESCUE SERVICES, INC.ADOPTION APPLICATION, PAGE TWO
Are you planning on moving within the next 6 months?_________________What will happen to this pet if you have to move?______________________________________________What will happen to this pet if you go on vacation or in case of emergency?__________________________Does your home have a pet door?_____________________Does your home have a fenced yard?___________________
 
Is the fence at least 6 feet high?_________________
 
Any gaps, holes or weaknesses in the fencing?__________________If there is no fencing, how will the dog be exercised?___________________Who will walk the dog and how often?___________________________Will you allow the dog to ride in the back of a pickup truck?___________________Why do you want to adopt a dog?___________________________Please list all people in your household who will be living with the dog, along with ages, including yourself.1.2.3.4.5.Did your entire family agree to this adoption?_______________Will everyone share in the care of this pet?_________________Does anyone in your household have allergies, and if so what are they?__________________Will there be any children that will visit your home frequently?_________________________Are there any regular visitors to your home, human or animal, with which your pet must get along?__________How often will you be feeding the pet?_______________How often do you feel a pet should see a veterinarian?_______________________What do you know about heartworms?__________________________What will you feed your pet?_________________________What behavior do you find unacceptable?________________________How will you correct unacceptable behavior?______________________
 
 
CINAGRO FARM RESCUE SERVICES, INC.ADOPTION APPLICATION, PAGE THREE
NO ANIMAL WILL BE ADOPTED WITHOUT FIRST BEING NEUTERED, MICRO-CHIPPED ANDEXAMINED BY OUR VETERINARIAN. We may or may not ask for financial assistance in thisregard.IF SELECTED TO ADOPT YOU WILL BE REQUIRED TO SIGN AN ADOPTION CONTRACT.
WE RESERVE THE RIGHT TO REFUSE AN ADOPTION!I certify that the above information is true and understand that false information may result in nullifyingthis adoption.
Applicant’s signature:_______________________________Applicant’s signature:_______________________________Date:__________________
CIRCLE ONE
APPROVED NOT APPROVED
Cinagro Farm Rescue Services, Inc.:_______________________________Printed name:_______________________________Date:__________________

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