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Small Animal Adoption Application
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Small Animal Adoption Application
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APPLICANT INFORMATION
APPLICANTS MUST BE 18 OR OLDER.
Adoption Applicant
*
First
Last
Applicant 2
*
First
Last
Address
*
Address Line 1
City
State / Province / Region
Postal Code
Mobile Phone
*
Home Phone
Email
*
What type of home do you reside in?
*
House
Condo
Duplex
Apartment
Do you own or rent your home?
*
Own
Rent
Please provide landlord’s name:
*
Landlord’s phone number:
*
REFERENCES
Please provide the name and phone number of two (NON-FAMILY) references that are aware of you and/or your families’ interaction with pets (ie: vet, neighbour or friends):
Reference 1
*
First
Last
Phone
*
Reference 2
*
First
Last
Phone
*
ANIMAL INFORMATION
What animal are you applying for?
Name
*
Breed
*
Type
*
Sex
*
Age
*
ADDITIONAL INFORMATION
Do you have any additional information you would like to share with us?
*
Yes
No
If there is anything additional you would like to add, please do so here:
*
ADOPTION TERMS
Please read and agree to the following adoption terms:
I agree that I have the appropriate housing for this animal.
*
I/We Agree
I am aware of and willing to provide the proper husbandry, exercise, diet and supplements required to keeping this animal in healthy condition.
*
I/We are aware and agree.
I have researched the requirements for this animal’s needs thoroughly and understand them.
*
I/We are aware and agree.
I am willing to provide any special needs this particular animal may require.
*
I/We Agree
I agree to contact Persian Dreams & Canine Themes Rescue Society in the event that I am unable to keep this bird for any reason.
*
I/We Agree
I am prepared to pay the stated adoption fee for this animal.
*
I/We Agree
I agree that all the information I have given on this application is complete and correct.
*
I/We Agree
ADOPTION TERMS ACCEPTANCE
Applicant Signature
*
Date
*
Applicant 2
Date
The information provided in this document is confidential and will only be shared with the adoption applicant’s consent.
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