Rock N Acres Animal Rescue Adoption Application

Todays Date *

First Name *

Last name *

Spouse or other party (first and Last name)

Home Address (No P.O. Box) *

City *

State *

Zip Code *

Home Number *

Cell Number

Work Number

Email Address *

Place of employment?

What is the best way and time to contact you?

Are you 21 years of age or older? *

Yes No

If under 21, What is your age?

What is your age?

What type of animal are you looking to adopt?

Which pet are you interested in adopting?

Why do you want to adopt a pet? *

Does anyone living in your household have any known allergies to animals?

Yes No

If so, What kind of allergies?

Have you owned a pet before?

Yes No

What pets currently live in your household?

Are your pets Kept Indoors or Outdoors? (Explain)

Please list the pets you have had within the past 3 years and explain what happen to them.

Are your pet(s) spayed and neutered? *

Yes No

If not, Please explain why

Are your current pet(s) up to date on all vaccinations?

Yes No

If not, Please explain why

Do you have a veterinarian? *

Yes No

If so, Please identify: Name/Clinic, phone number, address *

If you do not have a vet at this time, Have you had a vet before?

Yes No

If so, Please let name, location, phone number of your last vet.

Will you allow above named vet to release information regarding all current and former pets to Rock N Acres?

Yes No

Does everyone in the household know you are planning to adopt a pet?

Yes No

Do you own your home , rent your home/apt, or live with parents ? *

If renting, Who is your landlord and their phone number?

If you rent, does your landlord allow pets?

Yes No

How long have you been at this address?

Any children?

Yes No

What ages?

Do you have a completely fenced in yard, If so what kind and how high?

How long to you plan to keep this pet?

Should you move unexpectedly, what will become of the pet?

What behaviors would you consider unacceptable in your pet?

How would you correct these behaviors?

Do you agree to keep your pet on a leash while out doors
& off your property as required by local and state leash laws? *

Yes No

How will you keep your dog confined to your property?

How Many hours a day will your pet be alone?

Where will the pet stay when alone?

Where will the pet sleep?

If you travel, how will your pet be cared for?

If outdoors, what kind of shelter will be available to protect the pet from the elements?

Who Will financially support this pet? *

Do you plan on spaying or neutering the pet you want to adopt(If not already altered)? *

Yes No

Are you prepared for the costs involved
in properly caring for a pet (ex. food, treats, toys, grooming, shots, etc.)? *

Yes No

Are you aware that if you adopt a pet from our rescue,
you are required to return the pet to us
at your own expense if you can no longer keep it? *

Yes No

Would you object to an authorized member of Rna inspecting your residence? *

Yes No

Please List At least 2 Reference(must include name, phone number, and address) *

How did you hear about Rock N Acres Animal Rescue and our adoption services? *

If "INTERNET", Please tell us from what Site you found us.

Have you adopted a pet from us before or any other rescue/organization? *

Yes No

If so, Which pet did you adopt from us?

Which other rescue/organization have you adopted a pet from?

Anything else you think we might need to know or you want to tell us?

If you are not a local adopter, would you be able to pick up the pet
or would you need a transport arranged for this pet?

All of the information I have provided is true and complete to the best of my knowledge.
I agree To provide the pet with adequate food, water, shelter, affection and medical care *

True False

Do you understand that We reserve the right to refuse any adoption to any person for any reason *

Yes No

Signature(First and last name): *