AMBPR Adoption Application

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

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:

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”) *

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

Pet Name:

Dog/Cat: Dog Cat

Where Obtained:

Age (Yrs):

Pet Breed:

Currently in Home: Yes No

Deceased Year:

Declawed? Yes No

Pet Name:

Dog/Cat: Dog Cat

Where Obtained:

Age (Yrs):

Pet Breed:

Currently in Home: Yes No

Deceased Year:

Declawed? Yes No

Pet Name:

Dog/Cat: Dog Cat

Where Obtained:

Age (Yrs):

Pet Breed:

Currently in Home: Yes No

Deceased Year:

Declawed? Yes No

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

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

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

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