Adoption Form | Jamie’s Rescue

General Information

Date*

Dog you wish to adopt*

Your name*

Your address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your email*

Your phone (include area code)*

Your age*

Your occupation*

Household Information

Total number of adults in your household?*

Please list their occupations:*

Are there any children in your household?*

No
Yes

Please list their ages:*

Does any member of your household have known pet allergies?*

No
Yes

Please explain:*

Is everyone in your household ready to accept the responsibilities of adopting a new family member?*

No
Yes

Physical Premesis Information

Which of these accurately describes your home?*

Do you rent or own your current residence?*

Rent
Own

May Jamie's Rescue contact your landlord to ensure this pet is permitted to reside in your home?*

No
Yes

Landlord's name*

First Last

Landlord's phone (include area code)*

Does your residence have a yard?*

No
Yes

Is your yard fenced in?*

No
Yes

What kind of fence?*

How tall is the fence?*

Does the fence have a gate?*

No
Yes

Is there a dog door on the premises?*

No
Yes

Does your residence have a swimming pool?*

No
Yes

Is your swimming pool fenced in?*

No
Yes

Is there a weight or size limit on pets in your community?*

No
Yes

Community limit:*

Past and Current Pet Information

Will this be your first dog or cat?*

No
Yes

Please describe your PAST dogs and cats:*

Dog or Cat?	Age	Sex	Breed	Why are they no longer your pet?	Obedience trained?

Click the plus sign on the right to add additional rows for additional pets

Were any of your past pets euthanized?*

No
Yes

Please explain:*

Do other dogs or cats currently reside in your household?*

No
Yes

Please describe your CURRENT dogs and cats:*

Dog or Cat?	Age	Weight	Sex	Breed	Spayed or Neutered?	Vaccinations current?	Obedience trained?

Click the plus sign on the right to add additional rows for additional pets

What do you feed your current pets?*

Dry food
Canned food

Please explain how you believe your existing pets will adapt to a new pet in your home:*

Do you have a veterinarian?*

No
Yes

Veterinarian's name:*

Veterinarian's phone (include area code):*

Veterinarian's city and state:*

Pet Care Information

What will be this pet's primary role?

Are you willing and able to commit to this pet's care and be responsible for this pet over the next 10 to 15 years?*

No
Yes

Please explain:*

Will you keep your new pet up to date on vaccinations?*

No
Yes

Are you able and prepared to exercise your new pet regularly?*

No
Yes

How will you ensure your pet receives regular exercise?*

Will your new pet be an inside only pet?*

No
Yes

Where will your pet be kept during the day?*

Where will your pet be kept at night?*

Please explain how many hours each day your new pet will be without human companionship or supervision and why.*

Do you plan to cage your new pet at any time?*

No
Yes

Please explain when and for how long:*

Do you plan to keep your new pet tied up at any time?*

No
Yes

Please explain when and for how long:*

Do you plan to keep your new pet in a garage at any time?*

No
Yes

Please explain when and for how long:*

If your new pet is not housebroken (potty trained), which housebreaking training method will you use?*

Is someone at your residence available during working hours to care for your new pet?*

No
Yes

Who will care for your new pet during working hours?*

Who will care for and supervise your pet if you need to leave town for several days?*

If you move, will you take your pet with you?*

No
Yes

Please explain:*

Have you ever turned one of your pets over to a shelter?*

No
Yes

Please explain:*

Would you allow your pet to ride in the flat bed of a pickup truck?*

No
Yes

How much are you willing or able to spend on medical bills for your pet?*

What would you do if informed that a medical bill to ensure your pet's health and quality of life would exceed this amount?*

What steps will you take or provisions will you make should you become unable to care for this pet responsibly?*

Use this area to enter additional comments:

Adoption Application

General Information

Household Information

Physical Premesis Information

Past and Current Pet Information

Pet Care Information