AMBPR Adoption Application

NAME OF ANIMAL

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

Name of Animal you wish to adopt?*

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:*

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:

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?*

REFERENCES

Do you have a Veterinarian?* Yes No

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

CONSIDERATIONS

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

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, add this email address to your Safe Sender List.

Someone will contact you as soon as possible.

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

If you are interested in a different pet than the one entered in this application, please email us at applications@adoptmebluegrasspetrescue.com.

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