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Online Small Animal Applicaton

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Animal Information

Date

Animal Name *

Sex

Species

Breed *

Color/Marking *

Age *

Applicant Information

Name *

Phone *

Dropdown *

Email Address

Address *

City *

State *

Zip Code *

Age *

Occupation *

How long have you worked in this job? *

Do you have your own transportation? *

Yes
No

I live in a

Home Ownership

How long have you lived here? (Years & Months) *

Renter Information:

Landlord Name: *

Landlord Phone: *

Does your landlord allow pets? *

Yes
No

What is the maximum number of pets you can own? *

Are you required to pay additional rent per pet? *

Yes
No

If so, how much? *

Is your landlord aware of any current pets in your home? *

Yes
No

How long is your lease for? *

Do you plan to move when your lease expires? *

Yes
No

What plans do you have for your pet if you do move? *

Home Information:

How many people currently live in your home? *

Please indicate the number of adults and children. Please list the ages of the children.

Is the animal you are applying for a gift for someone?

Yes
No

If so, for whom?

Does this person live in the same residence?

Yes
No

Who will be responsible for the care of this animal? *

Does everyone in the household agree to this animal being part of your family? *

Yes
No

Is anyone in your household allergic to animals? *

Yes
No

Is anyone in the household currently pregnant? *

Yes
No

How many pets are in your home? *

How many dogs?

How many cats?

How many other pets?

Please list the the breed and ages of all pets and if they are good with other animals:: *

Who has access to your home, and will take care of your pets, in case of an emergency? *

What is their phone number?

My current pets reside... *

Indoors
Outdoors
Both

Who is your current veterinarian? *

Who's name are the records under?

Do you plan to use a different vet for your new pet? *

Yes
No

What veterinarian do you plan to use for your new pet? *

What is your veterinarian's phone number?

Are your current pets spayed or neutered? *

Yes
No

Are your current pets up-to-date on vaccines? *

Yes
No

What kind of food do you feed your current pets? *

Where will this animal reside? *

Indoors
Outdoors
Both

What veterinarian do you plan to use?

References:

Personal reference #1: *

Phone: *

Relationship: *

Personal reference #2: *

Phone: *

Relationship: *

Do you have experience with the species of animal you are applying to adopt?

Yes
No

Explain your experience with the species of animal you are applying to adopt?

Have you ever adopted from an animal shelter or rescue? *

Yes
No

Have you ever been denied adoption from an animal shelter or rescue? *

Yes
No

Please explain why your adoption was denied: *

Have you ever given up an animal? *

Yes
No

Please explain why you gave up an animal: *

Have you ever been accused of an animal related offense such as animal cruelty, neglect or abandonment?

Yes
No

If so, please explain.

What happened to the last animal you owned?

If the answer to above is "passed away", what did he/she pass away from?

What makes you a great pet owner?

Statement of Understanding *

I am aware that pets can live up to 25 years and I am prepared for this lifetime commitment. I certify that all of the above information is true and allow NLRC to contact my vet and personal reference to verify. I have never been accused of animal cruelty/neglect. I agree to a home check. Ninth Life Rescue Center reserves the right to deny or revoke any adoption at any time.

Electronic Signature *

Entering your full name here will be considered a valid signature.

Date *

ninthliferescue.com

Online Small Animal Applicaton

Animal Information

Applicant Information

Renter Information:

Home Information:

References:

PLEASE CLICK ON THE "SUBMIT" BUTTON BELOW TO COMPLETE YOUR APPLICATION!

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