First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Are you a US Resident? If No, explain:

County:

Employment Information

Name of Employer (if applicable):

Please list members of your household, relationship and ages (include self): *

In what type of home do you live?*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home?*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have a pet?
Choose one: Yes No

Have you or will you pay any and all applicable pet deposits?
Choose one: Yes No

If you rent, please enter your landlord's name and phone number:

Name of Current Pet #1

Current Pet Age:

Please check all applicable boxes for Pet 1

Name of Current Pet #2

Age Of Animal:

Please check all applicable boxes for Pet 2

Please list any additional pets you have owned in the past 10 years and indicate if cat/dog, spayed/neutered and if living/deceased. If deceased please list cause of death.

List the name and phone number of your veterinarian(s).

May we contact your vet for a reference?
Choose one: Yes No

List the name and phone number of two individuals for pet references:*

What type of pet are you interested in adopting?
Choose all that apply: Dog Cat

Which pet are you interested in?
Choose an animal: Bishop Charles Rocky Charlotte Cooper (FKA Mayor (Phenix)) Cupid Dolly - Foster to Adopt Elvis Lucky Lulu Moose Poppy Lee Queenie Rufus Star Dancer Teddy Valentine

If your first choice is not available, who is your second choice?
Choose an animal: Bishop Charles Rocky Charlotte Cooper (FKA Mayor (Phenix)) Cupid Dolly - Foster to Adopt Elvis Lucky Lulu Moose Poppy Lee Queenie Rufus Star Dancer Teddy Valentine

Other animals you are considering:

How long have you been thinking about getting a pet?

Who in the household will care for the pet?*

What traits are you looking for in a pet?

Where will the pet spend the majority of the time?*
Choose one: Inside Only Outside Only Mostly Inside with some outside time Inside and outside equally

Will the pet be the only pet in your home? Explain:

Where will the pet be kept when you are home?*

Where will the pet be kept when you are not home?*

How much time will the pet spend alone during the day?*

Where will the pet sleep?*

Describe how you will train the pet:*

Check any of the following reasons you would give your pet away:

Have you ever given up a pet? If yes, please explain*

Have you ever adopted a pet from a rescue group or humane society? *
Choose one: Yes No

If yes, when and which group did you adopt from?

How did you hear about us?*

A well cared for pet may live over 12 years. Does your lifestyle, career and family plans allow you to make this commitment?
Choose one: Yes No

Owning a pet is a serious financial responsibility. Are you prepared financially to spend a MINIMUM of $500 per year for veterinary care (vaccinations, flea/tick and heartworm preventative) IN ADDITION to the cost of food, toys, training and treats?
Choose one: Yes No

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence?
Choose one: Privacy Chain Link Invisible

What is the height of the fence?

For cats only: Are you planning to declaw?
Choose one: Yes No

Would you have any objections if a RUFF volunteer made a follow-up call or visit after the adoption?