AMBPR Adoption Application

Adopt Me Bluegrass Pet Rescue

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**PLEASE NOTE: WE RECEIVE HUNDREDS OF APPLICATIONS PER MONTH. WE REVIEW APPLICATIONS IN THE ORDER RECEIVED; HOWEVER, WE USE A "FIT FOCUS" PHILOSOPHY, AND OUR GOAL IS ALWAYS TO FIND THE PERFECT FIT FOR OUR RESCUES AND THEIR ADOPTERS.**

Required entries are designated by an * (asterisk).

Upon completion of this form, look for the "Submission Successful," pop-up. If your submission was successful, you will receive an email confirming your Application was received.

If you don't see the "Submission Successful" pop-up, please look in the upper right-hand corner of your screen for errors or omissions.

If you do not receive a confirmation email, and your submission was successful, please check your spam folder, and add us to your "safe senders" list.

NAME OF ANIMAL

Name of Animal(s) you wish to adopt?*

Type of Animal you wish to adopt:* Dog Cat

There is often a delay with other websites adding/removing available Dogs. Prior to submission, please verify this Dog is still available at: Adoptable Dogs

There is often a delay with other websites adding/removing available Cats. Prior to submission, please verify this Cat is still available at: Adoptable Cats

If undecided, what are your preferences? Breed, Age, Sex, Size, Coat Length, etc:

APPLICANT

Last Name:* First Name:* Nickname: Full Name

Street Address:* City:* State:* Zip Code:*

*Applicants must be at least 21 years old.

Birth Day:* Birth Month:* Birth Year:* Date of Birth: Todays_Date Age

E-Mail Address:* Phone Number:*

Driver's License Number:* Driver's License State:*

Employment Status:* Employed Unemployed Retired Student

Employer: Employer Phone Number:

How did you hear about us?* Friend
Relative
Adopt Me! Bluegrass Pet Rescue Website
Petfinder.com
Adopt-A-Pet.com
Facebook
Other (please list)

Other:*

Do you have a Co-Applicant?* Yes No

CO-APPLICANT

Last Name:* First Name:* Nickname: Co Full Name

Address same as Applicant Street Address:* City:* State:* Zip Code:*

Birth Day:* Birth Month:* Birth Year:* Date of Birth

E-Mail Address:* Phone Number:*

Driver's License Number:* Driver's License State:*

Employment Status: Employed Unemployed Retired Student

Employer: Employer Phone Number:

ALLERGIES/MEDICAL CONDITIONS

Please list any medical reason that might cause you to return this pet to us? (If none, enter “None”)*

Has everyone in your household been exposed to cats?* Yes No

FAMILY INFORMATION

ADULTS and/or CHILDREN living in your home.

Number of Adults in Home:* Ages of Adults:*

Number of Children in Home:* Ages of Children:*

HOME INFORMATION

Do you currently Own or Rent?* Own Rent Type of Residence?* Condo
House
Mobile
Apartment
How long have you lived at your current residence?* If you rent, we require proof that owner/management allows pet(s). Including payment of pet deposit. Enter your Initials to agree.* Please use "Choose File" button to upload Rental Agreement showing pets allowed.*

PET INFORMATION

Is this your first dog/cat?* Yes No

Please list any and all types of animal(s) you have owned in the past 5 years, beginning with the most current.

*PLEASE NOTE: Applicant's dog(s)/cat(s) must be spayed/neutered and up-to-date on vaccinations and preventatives in order to be considered for adoption placement.

Applicant's dog(s) must have updated Heartworm tests, and cat(s) must be Feline leukemia (FeLV) negative.

Pet Name: Dog/Cat: Dog Cat Where Obtained: Age (Yrs): Pet Breed: Currently in Home: Yes No Deceased Year: Declawed? Yes No

If seeking a puppy, have you ever raised one? Yes No If you raised a puppy, how long ago was that?

REFERENCES

Have you previously adopted a Dog or Cat from Adopt Me! Bluegrass Pet Rescue?* Yes No

Do you know a person(s) directly involved with or closely related to our rescue? (Please List)

Please list a Personal Reference:*

Phone Number for your Reference:*

Do you have a veterinarian, or have you had a veterinarian in the last five years?* Yes No

PLEASE NOTE: Your application cannot be processed, and will be rejected, without the release of your pet's medical records. Please contact your veterinarian and verify you have specifically authorized the release of medical information to Adopt Me! Bluegrass Pet Rescue.

Please enter the Veterinarian information for the Pets listed above.

Veterinarian:*

Phone Number:*

How long have you been seeing this vet?*

Did you authorize the release of your pet’s medical history?* Yes No N/A

PLEASE NOTE: Your application cannot be processed, and will be rejected, without the release of your pet's medical records. Please contact your veterinarian to verify you have specifically authorized the release of medical information to Adopt Me!

PET ENVIRONMENT AND CARE

I (we) clearly understand the lifetime commitment (financial, time, training) of adopting a dog or cat, and agree to allow for adequate time (at least 60 days) for both adopter(s) and adoptee to adjust to this major transition.* Yes No

*PLEASE NOTE: Most of our dogs require fences. In some cases, apartments with fenced dog parks are acceptable.

When outside, how do you plan to safeguard your pet? (Check all that apply )* N/A, Indoors only
Fence
Enclosed Patio
Tie-out chain
Dog Kennel
Garage
Doggie Door
Loose in yard, unattended

If you have a fence, what kind?* N/A, I do not have a fence
Wood
Chain-link
Picket
Invisible
Apartment Dog Park
Other

Other (Please List):*

On average, how many hours per day will your pet be kept inside?*

On average, how many hours per day will your pet be kept outside?*

When inside, how do you plan to keep your pet? (Check all that apply )* Free inside the house
Crate
Inside a closed room

How many hours a day will your pet be home by itself?*

What is the activity level of your home?* Very Quiet
Moderately Quiet
Active
Very Active

How do you plan to exercise your pet?* Leash Walk
Supervised time in yard
Unsupervised time in yard
Dog Parks
Doggie Day-Care

Do you plan to declaw your cat?* Yes No

Are you looking for a "barn cat?"* Yes No

If needed, would you seek professional training guidance?* Yes No

Who will be the primary person caring for the pet?* Age of person:*

If your pet were to survive you, who will take responsibility for him/her?*

Have you ever, or would you ever consider rehoming your pet or relinquishing them to a shelter?* Yes No

Do you have any additional information that might be helpful in the review of your application? (500 chars left)

CONSIDERATIONS

**PLEASE READ THIS SECTION CAREFULLY:**

1) Filling out an application does not guarantee your approval for the companion animal you are seeking. The proper fit for family and pet weighs heavily on our approval/denial decision.

2) Adopters must be 21 years of age and be able to financially support the pet.

3) Applicant must have a valid drivers license.

4) Adopt Me! will adopt out of state, but we do not supply transportation. Client would have to arrange for transport.

5) All of our pets are spayed/neutered, microchipped, heartworm/feline leukemia tested and up-to-date on vaccinations to include rabies - DHPP/FVCRP and bordatella.

6) Adoption Donation**: *Please note that we reserve the right to charge an increased adoption fee for purebreds and specialty breeds.*

	Adult Dogs (3 - 7 yrs)	$275 - $300
	Puppies & Young Adults (6 wks-2 yrs)	$375
	Paws Behind Bars Trained	$375
	Service Dogs	TBD
	Adult Cats	$125
	Kittens	$150

7) Applicant will be required to review and sign an Adoption Agreement prior to completion of adoption.

Payment is accepted at time of pet pick-up. We accept cash, check, or PayPal.

**Fees do not include KY sales tax.**

SIGNATURE

Applicant Signature: * (Please type Applicant's Full Name in the box below)*

* Agreement: By entering my name in the box above, I confirm that to the best of my knowledge, all information furnished in this application is true and correct. I hereby give permission to my veterinarian, personal references, landlord and employer to confirm and disclose information to Adopt Me! Bluegrass Pet Rescue for the purpose of processing my application.

After the "Submission Successful," pop-up, you will receive an email confirming your Application was received. If you don't see the pop-up, please look in the upper right-hand corner of your screen for errors or omissions. If you do not receive a confirmation email, and your submission was successful, please check your spam folder, and add us to your "safe senders" list.

FOR INTERNAL USE

Date Received

Initial email sent to applicant

Review Started

Review Completed

Application Forwarded

Application Declined

Applicant Notified

Status

Submission

Successful!

Thank you for your application.

You will receive a confirmation email from applications@adoptmebluegrasspetrescue.com. If you have not received this email, please check your Spam Folder. Also, please add this email address to your Safe Sender List.

Your application will remain on file with Adopt Me! Bluegrass Pet Rescue for 6 months.

If any of the information on your application changes, please notify us at applications@adoptmebluegrasspetrescue.com.

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