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Beach Cities Reptile Rescue

www.BeachCitiesReptileResccue.org

Phone: 949.424.3256

Animal Adoption Application


Applicant Information
Last Name: Address: City: Home Phone: Email Address: Do you Own? Landlords name: Rent? Any plans to move in the near future: Landlords phone: State: Cell Phone: First Name: DOB: Apartment #: Zip Code:

Family / Household Information


Number of adults in the household: Have all the adults in the household agreed to this adoption? Number of children in the household: Have the children had pets before? Relationships:

Yes

No

Age of children:

Pet Information
Have you had pets in the past or do you currently have pets? Please tell us about them. Name Species Age Gender Where are they?

M M M
Have you ever given an animal away or relinquished an animal to a shelter? If yes, what were the circumstances?

F F F

New Pet Information


How long have you been looking for a pet? What will you feed your new pet? How often will you feed your pet?

How much time are you prepared to allow for your pet to adjust to your home? Where will you keep your pet? Describe your new pets enclosure:

Are you committed to providing a responsible home for your pets entire life (15+ years)? Are you able to afford a bill of $200 (or more) for emergency veterinary care? Who in the household will be your pets primary care giver? When you are out of town, who will be the primary care giver? In case of emergency, who will care for your pet?

Yes
No

No

Yes

Phone: Phone:

By signing below, I certify that the information given is true. I understand that Beach Cities Reptile Rescue may deny my application for any reason. I further authorize the investigation of all statements in this application

Applicant: _____________________________________________ Date Application Received: Date Emergency Contact Contacted: Any Concerns: Is another appointment needed? Yes Date Application Accepted Reason if Denied : Date Contacted:

Date: ______________________

To be filled out by a Beach Cities Reptile Rescue member


Did they agree: Yes

No

No

Date:

Contact Info: Animal adoption location:

Denied :

Member Signature: ___________________________________ Date: ____________________