Adoption Application* indicate required informationPet Name (if applicable) or type interested in: Animal Adopting - Your selection will send the application to the correct adoption team. Puppy Adult Dog Senior Dog Adopters and Adult Residents in HousePlease include ALL adults - spouse, partner, roommates, children 18+, friends, parents, etc.Primary Adopter - Name* First Last Phone*Email* Place of Employment* Age* How did you hear about Save-A-Mutt?* Do you currently have applications submitted to other rescue organizations for a pet?*YesNoDo other adults (18+) live in the home either part time or full time?*YesNoPlease list all other adults (age 18+). Use 'plus sign' to add additional adults.*Full NameEmailPhonePlace of EmploymentRelationshipAge Home InformationHome Address (where pet will be living)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Type*HouseCondominiumApartmentOther RentalHome Status*OwnRentLive with someoneAre pets allowed? Yes No Landlord Information*Landlord Full NameLandlord Phone or Email AddressBy providing this information, you acknowledge that we will be contacting your landlord. How long have you lived at your current address?* Many adoptable dogs are ready to go home within a few days of application approval. Do you have any upcoming travel or 'out of town' plans that will limit your timeframe for adopting?* Yes No Have you or anyone in your home been charged / convicted of a crime involving an animal?* Yes No What are your plans? Do you feel it will affect your new dog?*Are you planning on a vacation or any other plans in the NEAR future that would delay your adoption?* Yes No For what reason(s) would your return your adopted pet?*Do you have children living or visiting the home?* Yes No Children Information*How Many / Relationship?Ages?Are you children used to animals? Yes No Is anyone living in the house allergic to animals?* Yes No Do all adult members of the household know you plan to adopt a pet? Yes No Pet LifestyleWhy do you want to adopt this animal?* Companion Companion for Kids Companion for other Pet(s) Guard/Watch Dog Hunting Dog Gift / Present Other Please check all that apply.You selected "other" please elaborate For DOGS - when this dog is outside, it will primarily be:In a Fenced YardOn a LeashAllowed to Run FreeTied Up/TrolleyOtherFor DOGS - If the yard is fenced, will it safely CONTAIN the dog? Yes No Fence DetailsType of FenceHeight of Fence What type of outside shelter will be provided? For DOGS - Are you willing to enroll the dog in an obedience class?* Yes No What type of activities do you foresee doing with your pet?Would you allow our representative to do a home check prior to adoption?* Yes No Pet Care and WellnessList ALL pets (Current / Deceased / Rehomed) that you have had in the last 7 years. List any roommate pets if applicable. Use 'plus sign' to add additional pets.NameBreed / TypeAgeGenderSpayed/Neutered?Current Status Are all of your pets current on their vaccinations?* Yes No Do you currently have a veterinarian?* Yes No Veterinarian InformationNamePhone NumberBy providing this information, you acknowledge that we will be contacting your veterinarian. PLEASE contact your vet office and give permission for us to talk to them. How much approximately are you willing to spend on vet bills per year? How will you financially handle medical emergency? NUMBER ONLY*Are you willing to obtain pet insurance for your new pet?* Yes No How many hours pers day will the pet be alone (without HUMAN companionship)? This is while at work, errands, etc.* Where will the pet stay during the day?* Where will the pet stay during the night?* Will this pet primarily live indoors? Yes No ReferencesPlease use references with EMAIL addresses ONLY. It is our preferred form of communication. We are looking for people that can comment to your ability to take care of an adopted animal, perhaps previous experience, etc. WE WILL NOT move forward with your application if you leave references blank. We treat each application with confidentiality - and References are valuable part of our process. Reference Information*NameE-Mail AddressRelationship Type Reference Information*NameE-Mail AddressRelationship Type Reference Information*NameE-Mail AddressRelationship Type Is there any other information you would like us to know? Previous pet history, more detail to above answers. Anything you want us to know in regards to adopting from Save-A-Mutt?Signature and Legal InformationBy signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal from Save-A-Mutt. This pet will reside in my home as a companion animal. I will provide it with adequate food, water, shelter, training, affection and medical care. I am in full agreement with these terms of adoption. Save-A-Mutt is in no way liable or responsible for any damage, accident or injury resulting from the placement of a pet in my household. Thank You.Signature* Δ
