CARE Adoption Form (FILL

Cressie Animal Refuge and Enrichment (CARE)
ANIMAL ADOPTION FORM
1614 Doe Park
San Antonio, TX. 78248
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APPLICATION FOR CANINE ADOPTION
Date:
Name of dog desired:
Color(s):
Applicant Information
Name:
Address:
City:
State:
Zip:
Telephone numbers: Home:
Work:
Cell:
E-mail Address:
Date of Birth:
Number of People in Household:
If children are in the household, please list ages:
Yes
Are you or any member of your family allergic to pets:
Are you presently:
Employed
No
Do all adults in home agree to the adoption?
Employer:
Unemployed
Retired
Student
Retired
Student
Co-Applicant Information
Name:
Relationship:
Telephone: Home:
Work:
Cell:
E-mail Address:
Are you presently:
Date of Birth:
Employed
Employer:
Unemployed
General Information
Type of residence:
House
If rental, are dogs allowed?:
Apartment
Yes
No
Condo
Mobile Home
Size Restrictions?
Yes
Farm/Barn
No
Max. Size:
Complex name/address:
Manager/Landlord:
Phone number:
Current housing location:
Type of street:
Where will dog live?
City Limits
Very busy road
Slight traffic
Inside only
Where will the dog spend nights?
Outside City Limits
Outside only
Inside
Country road
Mostly inside
Mostly outside
Outside
Do you have a fenced yard?
Yes
No
Will you pet be chained for any reason?
Yes
No
If Yes, how high?
How many hours per day will the dog be alone?
Describe the activity level in your home:
Residential area
Where will the dog stay when left alone?
Busy (visits by friends, meetings, children, parties at home)
Noisy (TV, stereo, machinery, tools, children playing, dogs barking)
Moderate (Normal comings and goings)
Quiet (homebodies, few guests)
Other (specify)
In the absence of the primary caregiver, who will care for the dog?
Under what circumstances would you rehome the dog ?
Other – specify
New Job
Divorce
New Baby
Move
Illness
Cressie Animal Refuge and Enrichment (CARE)
ANIMAL ADOPTION FORM
1614 Doe Park
San Antonio, TX. 78248
Are you willing to take responsibility if this pet acquires an illness for tests positive for heartworms?
Are you willing and able to pay the veterinary costs of caring for your new pet?
Yes
Yes
No
Are you willing to take the time to work with a dog on housebreaking or chewing, if such problems arise?
Would you consider obedience training for your new dog?
Yes
No
Yes
No
No
How much time are you prepared to allow for your new pet to adjust to your home?
Pet Information
Have you had pets in the last five years?
Name of Pet; Type of Pet
Yes
Years
Owned
No
If yes, complete the following chart
Spayed/Neutered
Inside/Outside
Yes
No
Inside
Outside
Yes
No
Inside
Outside
Yes
No
Inside
Outside
Yes
No
Inside
Outside
Yes
No
Inside
Outside
Current or past vet name of clinic:
Do you consider your dog a part of the family?
Where is Pet Now?
Phone:
Yes
Are you aware that a dog is a large and lifelong commitment?
No
Will your dog be on heartworm prevention?
Yes
How did you hear about the CARE?
Yes
No
No
Would you like to become a volunteer?
Yes
No
Personal References
# 1 Name:
Relationship:
Phone:
Best time to contact:
Comments:
I understand that this is a legal document and that, by signing below, I agree to, and am required to comply with,
all of its terms and conditions.
I accept full responsibility for any and all liabilities arising from or related to any present or future illnesses of the
adopted animal and any damage the adopted animal may cause to any person or property.
Once an adoption is completed CARE no longer accepts responsibility for the animal.
Adoption donations are non-refundable.
____________________________________________________________
Signature
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Date
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