AMBPR Adoption Application

NAME OF ANIMAL

*Please verify Animal is still available prior to submission.*

Name of Animal you wish to adopt?*

Type of Animal you wish to adopt:* Dog Cat

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:*

E-Mail Address:* Phone Number:*

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

Employment Status:* Employed Unemployed Retired Student

Employer: Employer Phone Number:

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:*

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”)*

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?* 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: Currently in Home: Yes No Deceased Year: Declawed? Yes No

If seeking a puppy, have you ever raised one? Yes No

REFERENCES

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

We will contact your veterinarian to complete a reference check on pets under your care over the last five years.

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

PET ENVIRONMENT AND 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:

	Adult Dogs (dogs 3 - 7 years old)	$225 - $275
	Senior Dogs (dogs 7+ years old)	$225
	Puppies & Young Adults (age 6 weeks - 2)	$295 - $395
	Paws Behind Bars dogs	$325 - $395
	Service Dogs	TBD
	Adult Cats	$75
	Kittens	$125

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.

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.

FOR INTERNAL USE

Date Received

Initial email sent to applicant

Review Started

Review Completed

Application Forwarded

Application Declined

Applicant Notified

Status