Adoption Application
Questions marked by * are required.
1.	Name of Animal you wish to adopt: *
2.	Name of Adopter *
3.	Street Address *
4.	City/State/Zip *
5.	Email address *
6.	Home phone *
7.	Are you in the process of moving? * Yes No
8.	Type of Residence * House Apartment Other Rent Own Live with family/friend
9.	If your residence is owned by a person other than yourself, do you have the owner/Landlord permission to bring a pet into your household? Yes No
10.	Have you discussed with your Landlord how adding this pet will affect your deposit/monthly payments? Yes No
11.	Landlord's Name and Phone Number
12.	Number in household: Adults __ Children__ *
13.	Do the other members of your household support your decision to adopt this pet? * Yes No
14.	Do any members of your household have allergies? * Yes No
15.	Is there someone home during the day? * Yes No
16.	On average, how many hours a day will this pet be left alone? * 1-3 4-6 6-8 more than 8
17.	When you are not home, this pet will be kept: * Inside loose Inside crated Outside in fenced yard Outside in kennel other
18.	What best describes your household? * Active Noisy Quiet Structured Chaotic Constantly changing
19.	Personal Reference #1 and phone # *
20.	Personal Reference #2 and phone number *
21.	Have you ever? given a pet away sold a pet surrendered a pet to a shelter/rescue lost a pet had a pet stolen had a pet picked up by Animal Control had a pet run away had a pet who was used for breeding had a pet hit by a vehicle had a pet poinsoned had a pet killed by a neighbor had a pet killed by another animal had a pet die of unknown causes
22.	List Current Pets: Species(dog/cat)- Gender- Age-Breed- Temperament/behavioral issues (if any)
23.	Do any of your current pets not get along with _ Dogs Cats
24.	Are all of pets currently living in your home current on all vaccinations and heart worm prevention? Yes No
25.	Are all pets living in your home spayed/neutered? Yes No
26.	Veterinarian Information: Name, Address, Phone Number *
27.	Do you plan to have this or any other pet kept on a chain? * Yes No
28.	Do you have a fenced area? * Yes No
29.	Type/height of fence:
30.	What type of exercise and socialization will you provide for your new pet? *
31.	What type of corrective action do you use when your pet misbehaves? *
32.	What type of issues would you be unwilling or unable to work with? *
33.	Under what circumstance would you consider returning this pet? *
34.	Are you willing /able to take on the financial commitment of providing veterinary care, grooming, emergency expenses, supplies, and food, for the lifetime of this pet- understanding that these expenses can often add up to the hundreds of dollars each year? * Yes No
35.	Agreement/Contract * Regard4Life Animal Rescue ANIMAL ADOPTION AGREEMENT/CONTRACT (To be completed upon finalization of adoption) If you experience any issues, or concerns, please contact us so that we can help you! THERE IS ALWAYS A SOLUTION!! ☺ Together, with the full payment of the required adoption donation fee, this Adoption Agreement/Contract constitutes a legal, and binding, contract between Regard4Life Animal Rescue and the Adopting Individual/Family – and gives the Adopter(s) the real, and legal, right to take possession of the pet, designated on the approved Adoption Application. Adopting Individual/Family, and Rescue, agree to comply with the following guidelines: Adopter(s) is at least 18 years of age and able to provide proof of age, and current address. Adopter(s) has the knowledge/consent of all adults who reside at the location where the adopted pet(s) will be housed. Adopter(s), who do not own their property, will provide proof of pet deposit (if required) and lease agreement verifying that pets will be allowed by property owner/manager. Adopter(s) will be responsible for the responsible care, and control, of the adopted pet, at all times. This includes; but, is not limited to, safe housing, good quality food, annual vet check-ups, vaccinations, maintenance treatment (i.e. flea treatment, heartworm preventative, etc), and immediate medical care, if sick or injured. Adopter(s) agrees to provide the adopted pet a loving, caring, healthy home for the duration of his/her life. Adopter will invest whatever time/effort is necessary to ensure their new pet has the highest possible chance of being a happy, healthy, well-balanced pet (i.e. exercise, house-training, crate-training, leash-training, basic training for mild behavioral issues, such as food aggression, anxiety, etc.). Adopter(s) may be required to consent to a home inspection by the Director, or designated representative of Regard4Life Animal Rescue. Adopter(s) agrees that, under no uncertain terms, will they have their pet declawed or keep them on a chain/cable. If Adopter(s) has other pets, Adopter(s) agrees to introduce the new pet slowly, and carefully – and will not leave them unsupervised during the adjustment period, or until it is clear the new pet is not in danger of injury or loss. Adopter(s) agrees that adopted pet is not to be re-homed or surrendered to another person, shelter, or rescue, without the knowledge, and consent, of the Regard4Life Animal Rescue Director(s). Regard4Life Animal Rescue takes the health and well-being of our rescue animals very seriously! We do everything we can to make sure we are adopting out healthy, well-adjusted animals. However; we rely solely on the information we are given at the time an animal is brought into our program. Unfortunately, there may be occasions when information regarding the history, health, and behavior of an animal is unavailable, incomplete, or inaccurate. We encourage every adopter to take their new pet to their veterinarian, within 72 hours for a complete examination! Agree Disagree