Journey Animal Rescue Adoption Application

The Long Journey Home to a New Beginning

Please answer the questions below and click on the Submit button to send us your adoption application

* indicates the field is required

Name of the pet you are applying for *

Your Contact Information

Name: *

Address: *

City: *

State: *

Zip: *

Home Phone: *

Alternate Phone:

Email Address *

Physical Address (if different then the one above)

Address:

City:

State:

Zip:

Additional Contact Comments

Tell us about your Residence

*Rent Own

If rent, please give us the name and phone number of your land lord *

Name:

Phone:

Number of years at this address: *

Will you be moving soon? *

Yes No

If yes, what will you do with your pets *

Do you have a yard? *

Yes No

If yes, is it fenced? *	Yes No
Type of fence *		Height *

Are you familiar with animal control laws in your area? *

Additional Comments About your residence:

Tell us about your household and family

Number of adults in household: *

Number of children in household * Ages? *

Does everyone in the household agree to the adoption of this pet? *

Is anyone in the household allergic to animals? *

Do you have an active or quiet household? *

Additional Comments About your household and family:

Tell us about your current and past pets

List all current pets in your household *:

Please give name, species (dog,cat,horse,etc), breed, M or F and spayed or neutered? and age of pets

List all pets/animals you have owned in the last 5 years that you no longer have *:

Please give name, species (dog,cat,horse,etc.), breed, Male or Female, spayed or neutered, Age, where the pets are now (re-homed, deceased,lost,etc). Please provide detail if re-homed or, if they died, circumstances of death.

Name and phone number of your current or previous veterinarian *:

Name:

Phone:

Have you ever given an animal away? If so, under what circumstances. If not, under what circumstances yould you give up your pet? *

Tell us about the pet you are applying for

Why do you want to adopt this pet? * Companion, guard dog, hunting, breeding,etc

Are you willing to spend the time adjusting your pet to its new environment and working through problems as they arise? *

Where will this pet be kept when you are home? *

Where will this pet be kept when you are not home? *

Where will this pet be kept when you have to go out of town? *

How will your pet be kept outside? *

How will you exercise this pet? *

How many hours per day with this pet be left alone? *

Are you planning or willing to take this pet to training classes? *

Are you able to provide for your pets medical expenses? *

Understanding that a dog may live up to 17 years, are you willing to make that committment for the life of your pet? *

Additional comments about why you are applying to adopt this pet:

Name and phone number of a personal reference *

Name:

Phone: