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					This application is to help determine if the proposed adoption is in the best interest of both the
pet and your family. The adoption includes, but is not limited to, the signing of this document, a
legal, binding contract.
The ultimate purpose of this application is to find the best possible home for the cat or dog. Your
new pet will be completely dependent on you for his/her health, happiness and love. The
contract is our written agreement of the terms and conditions under which the cat or dog is
given into your care.
Please be patient with our inquisitiveness and concern for our pets well being. We wish only the
very best for you and your new pet.
All questions must be answered as completely and honestly as possible.
After the application is filled out and returned we will schedule a time for you to visit. We also
request that a home visit be scheduled before the final adoption.

We reserve the right to refuse any adoption that is not in the best interest of any cat or dog.

Name:           _______________________________________________________________

Address:        _______________________________________________________________

Place of Employment:

Age:         _____________________

Phone:          (Home) ___________       (Work) ________ (Cell)_________

Primary Email Address:           _ _____________

Secondary Email Address:         ____________________________________

Please write why you would like to adopt a pet from us:

Cat/Dog’s New Home:

1. Is this cat or dog specifically for your household?
        (If this pet is not for your specific household, please have a responsible adult from the
        household where the pet will live to fill out this application).

2. Number of adults in your household:          children:     and their ages:__________
3. Does anyone in your household have allergies to animals?

4. Do all responsible members of your household agree to have a new pet?

Do you live in a: (Please check one)     house? ______ Apartment? ______ Mobile home?
______ other:
5. Do you OWN or rent?
6. If you rent are pets permitted in the rental unit?
        (Adoption will not be completed, until proof of "pet deposit" or “contract with pets and
        without deposit” is shown.)

7. Is your home a permanent residence?           Temporary residence? _____

8. Are you planning to move within the next few years?

        If you do move, what will you do with your new pet?

Other / Previous Pets

9. Is this your first pet?

10. If you have other pets now, what kind are they, how many are there, and their ages?

11. If you have no pet(s) now, have you had any pets in the last two years?

        Where are they now?

12. Have you ever adopted a pet before?

        If so, from what organization or individual?

        Where is the pet now?

13. Have you ever given or had to give up a pet for any reason to an organization or individual?
       If yes, When and Why?
Cat/Dogs Future:

14. Have you thought about the initial and future cost, and care that your new pet will require?

15. Do you have the time and interest necessary for acquiring a new pet?

16. Your new cat or dog may take up to two months or more to adjust to its new home. Are you
willing to allow it this much time to adjust?

       If not, why?

17. Would you object to follow-up calls and/or visits to check on your new pet’s progress?

        If yes, why?

18. Should your new cat or dog have behavior problems, are you willing to work them out, or call
me for help?

19. What will you do, if your new pet does not get along with present/future pet(s)?

20. Will your new cat/dog be kept basically inside?________         outside? _____

Cat/Dog Health:

Most rescued animals have unknown medical backgrounds. For this reason:

21. Do you agree to take your new cat or dog to a licensed veterinarian for a complete veterinary
exam within 72 hours (3 days) after the adoption and to follow-up on all inoculations as
recommended by a licensed veterinarian?

        Once the 72-hour exam has been completed, if your new pet becomes sick, you have the
        options to have the cat/dog treated at your own expense by a licensed veterinarian or
        return the pet to us.

22. Do you agree to have your new kitten/puppy spayed or neutered by a licensed veterinarian
on or before a specific date? (Most of the pets at the rescue are already altered; answer this
question only if you are adopting a kitten or puppy that is too young to be altered.)

23. If you have other pets, are they spayed/neutered?       Are they current on vaccines?

24. If you are adopting a cat or kitten, are you familiar with Feline Aids, Leukemia and Peritonitis?
25. If you are adopting a dog, are you familiar with heartworm, parvo, and other illnesses related
to not vaccinating your dogs?

26. Do you have containment that you will be using, if you are adopting a dog or puppy?
    If so, what size?    Inside?         Outside?        Do you have a fenced yard?

27. Who is your current veterinarian and what is his/her phone number? If you do not have a vet,
please provide us with 3 personal references that we may contact:

Do you agree that if it is found that you have abused or neglected this pet, you will relinquish
custody of your new cat or dog to us upon being asked? Initials _____

I understand that the cost of adoption is:
 $85.00 for cats and kittens __________
$130.00 for puppies and dogs__________
If the kitten or puppy has not been neutered a portion of the adoption fee will be refunded to
you after the pet has been altered and you send us proof of the surgery. I understand that this
cost will include, but is not be limited to, expenses incurred by the foster home during the pre-
adoption process, specifically veterinary fees related to this adoption.

I certify that the above information is true and that false information may result in nullifying this
Please sign below using electronic signature. (When you type your name here, we are allowed to
use this as your signature) Please sign the agreement below also.
Applicant's Signature:


Please fill out completely, and email to: or

As with all the pets that are adopted through Animal Adoption Network, if there is ever a need to
surrender this animal, for any reason, I promise to contact Animal Adoption Network or Pat
Armstrong and inform them before giving this animal up to another individual or organization.
We also reserve the right for this animal to be returned to our organization before being turned
over to any animal control agency or other organizations. It is understood that by signing below
that you agree to these terms and that by signing this agreement you agree to pay for all court
costs, if any applies, for the safe return of this animal.

Please sign below using electronic signature.
Applicant’s signature:                               Date:

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