Adoption Application

Name of Animal *

Type of Animal *

Your Name *

First

Last

Email *

Phone Number *

Occupation *

Are you aware of our adoption fee and have you considered the financial obligation of owning an animal, which can be $1,000 or more annually? *

Date of Birth (you must be 21+ to adopt) *

Primary reason for wanting an animal? *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Name/Age of Others in Household *

Description of other pets in household *

Type of dwelling *

Do you rent or own? *

Do you have permission from landlord to have this animal? *

Landlord's Name *

First

Last

Landlord's Phone Number *

Type of Yard *

Describe previous experience with animals? What kind? How long? *

Will the animal be indoor/outdoor? *

Would the animal be tied up? *

Percentage of time animal would be in house *

Is anyone at home during the day? *

How many hours will the animal be alone? *

Where will the animal be when home alone? *

Will you allow animal on furniture? *

Where will animal sleep? *

What is your level of exercise? *

Describe how you will train animal *

During vacation who will care for animal? *

Under what circumstances would you get rid of animal? *

Are you prepared to make a 15 year commitment to animal? *

Are you prepared to spend a lot of time with animal? *

What would you do if you could no longer keep pets? *

Reference that is not a family member *

First

Last

Reference Phone Number *

May we visit your home before and after the adoption? *

By hitting submit, you are agreeing to the following conditions:

I agree that if I adopt an animal, we will provide professional vet care, a healthy diet and a loving home.
I also agree that we will return the animal to Country Roads Animal Rescue Society if I can no longer keep it.
No member of my household has ever been convicted of cruelty to animals.

Submit

Adoption Application

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