Adoption Application Pet Adoption Application Fields marked with an * are required Date * I understand that this rescue is in Midland, MI. * I want to adopt a... Dog Cat Name of pet interested in adopting. * Applicant Information Applicant Information First name * Last name * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP code * Phone * Email * How many people live in the home? * 1 2 3 4 5 6 7 or more Ages of children in the home * Do you own or rent? * Own Rent If your rent, please provide name/phone number for leaseholder Pet History Pet History Please describe other pets you currently own * Are your other pets: (check all that apply) * Spayed/neutered Current on vaccines Indoor pets Outdoor pets Declawed Indoor/outdoor pets On flea preventative Please provide a brief history of pets you have owned (names, ages, or how long owned and cause of death) Have you or anyone in your home ever needed to surrender a pet? * Yes no If yes, please explain: Have you or anyone in your home ever been charged or convicted of animal neglect, cruelty, abuse, or domestic violence? * yes no If yes, please explain: Current Veterinarian: enter name of current vet and office. If no current vet then list: none at this time. * Phone of Current Veterinarian New Pet Information New pet Information My new pet will be * Indoor Outdoor Both My new pet needs to get along with * Cats Dogs Kids not applicable What is your preference for cats claws? * Will declaw Prefer a declawed cat if available Do not plan to declaw Where will the pet stay when no one is home? * Loose in house Crated Left in one room Garage Outdoors Where will the pet sleep at night? Who will be taking care of the pet? (Dog adoptions only) Do you have a fenced yard? Yes No (Dog adoptions only) How will the dog receive exercise? Under what circumstance would you consider giving away this pet * Financial Pet medical issue Moving/deployment Allergies A family member medical issue Behavioral issue Litter box issues (cats) House breaking issues (dogs) Children none of the above I understand that an animal can live 15-20 years and I am fully committed to giving this new pet a permanent, indoor, forever home. * yes no I am financially able to provide for the daily care as well as any required medical expenses necessary for long term care of this animal. * yes no If I am no longer able to care for this pet due to age or illness, I have a family member or friend that has agreed to take ownership and properly care for this animal? * yes no I/we hereby give permission for my veterinarian (identified on this application) to release to SOS Animal Rescue all information concerning my veterinary care of my current or past pets. * I agree I have never owned a pet I/we give SOS Animal Rescue permission to contact my landlord/association to verify that pets are allowed at my place of residence (identified on this application) * yes no Additional comments If you are a human seeing this field, please leave it empty. Pet Adoption Application Fields marked with an <span class="ninja-forms-req-symbol">*</span> are required Date * I understand that this rescue is in Midland, MI. * I want to adopt a... Dog Cat Name of pet interested in adopting. * Applicant Information Applicant Information First name * Last name * Address 1 * Address 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampsire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP code * Phone * Email * How many people live in the home? * 1 2 3 4 5 6 7 or more Ages of children in the home * Do you own or rent? * Own Rent If your rent, please provide name/phone number for leaseholder Pet History Pet History Please describe other pets you currently own * Are your other pets: (check all that apply) * Spayed/neutered Current on vaccines Indoor pets Outdoor pets Declawed Indoor/outdoor pets On flea preventative Please provide a brief history of pets you have owned (names, ages, or how long owned and cause of death) Have you or anyone in your home ever needed to surrender a pet? * Yes no If yes, please explain: Have you or anyone in your home ever been charged or convicted of animal neglect, cruelty, abuse, or domestic violence? * yes no If yes, please explain: Current Veterinarian: enter name of current vet and office. If no current vet then list: none at this time. * Phone of Current Veterinarian New Pet Information New pet Information My new pet will be * Indoor Outdoor Both My new pet needs to get along with * Cats Dogs Kids not applicable What is your preference for cats claws? * Will declaw Prefer a declawed cat if available Do not plan to declaw Where will the pet stay when no one is home? * Loose in house Crated Left in one room Garage Outdoors Where will the pet sleep at night? Who will be taking care of the pet? (Dog adoptions only) Do you have a fenced yard? Yes No (Dog adoptions only) How will the dog receive exercise? Under what circumstance would you consider giving away this pet * Financial Pet medical issue Moving/deployment Allergies A family member medical issue Behavioral issue Litter box issues (cats) House breaking issues (dogs) Children none of the above I understand that an animal can live 15-20 years and I am fully committed to giving this new pet a permanent, indoor, forever home. * yes no I am financially able to provide for the daily care as well as any required medical expenses necessary for long term care of this animal. * yes no If I am no longer able to care for this pet due to age or illness, I have a family member or friend that has agreed to take ownership and properly care for this animal? * yes no I/we hereby give permission for my veterinarian (identified on this application) to release to SOS Animal Rescue all information concerning my veterinary care of my current or past pets. * I agree I have never owned a pet I/we give SOS Animal Rescue permission to contact my landlord/association to verify that pets are allowed at my place of residence (identified on this application) * yes no Additional comments If you are a human seeing this field, please leave it empty.
