Adoption Application* indicate required informationPet Name (if applicable) or type interested in: 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+)*Full NameEmailPhonePlace of EmploymentRelationshipAge Home InformationHome Address (where pet will be living)* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home TypeHouseCondominiumApartmentOther RentalHome StatusOwnRentLive 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? Do you plan on moving within the next year? Yes No If you move in the future, what will you do with your pets?Are you planning on a vacation 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 at home?* Yes No Children InformationHow Many?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 Details*Type 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 AND roommate pets if applicable.NameType / BreedAgeGenderFixed?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 are you willing to spend on vet bills per year?*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. 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 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
