Companion Connection

Adoption Application

Print, complete and Email form to VillageRescue@gmail.com or fax to 512-285-5614

ANIMAL ADOPTION APPLICATION
For:                                 

(Please print)

  APPLICANT INFORMATION

Name:	Address:
City, State, Zip:			Email:
Phone Numbers:  Home:		Work:		Cell:
Employer:		SSN or ID No (DL#).:

 

HOME INFORMATION

_ Own   _ Rent	If Renting, are pets allowed?	Yes           No
If renting, please provide Landlord’s Name and Phone Number or written consent to have companion animals.	Name:
	Phone:	Cell Phone:

 

MEMBERS OF HOUSEHOLD (including self)
PERSON NAME                                                                                                         RELATIONSHIP                             AGE             ALLERGY TO ANIMALS?

	Self		Yes            No
			Yes            No
			Yes            No
			Yes            No

 

Pets:

TYPE (Species/Breed)                                           GENDER                                       FIXED (Spay/Neuter)?              AGE            SHOTS CURRENT?

	Male           Female	Yes                No		Yes           No
	Male           Female	Yes                No		Yes           No
	Male           Female	Yes                No		Yes           No
	Male           Female	Yes                No		Yes           No

 

QUESTIONS

1.  If your pet(s) are not fixed, why?
2.  If your pet(s) are not current on shots, why?
3.  If you go on vacation, what will you do with this companion animal?
What is your reason for adopting?
Will this adopted pet live mostly indoors or outdoors?			Indoors        Outdoors             Both                              Dog/Cat Door?
If adopting a dog, is your yard fenced?        Yes      No   If not, what arrangements will you make for exercise?
How many hours per day will this pet be left alone?

 

REFERENCES

Veterinarian Name:	Telephone #:
Personal (non related): Name:	Telephone #:

 

I certify that I am 18 years of age or older, and the above information is true and accurate to the best of my knowledge. And I am willing and able to provide the time and money necessary to medically treat, train and care for a companion animal.

 

__________________________________________________________________     ____________________________
                             Signature                                                                                                           Date

 

Print, complete and Email form to VillageRescue@gmail.com or fax to 512-285-5614

"The greatness of a nation and its moral progress can be judged by the way its animals are treated...

I hold that, the more helpless a creature, the more entitled it is to protection by man from the cruelty of man." -Mahatma Gandhi-