Animal Rescue League of Marshalltown1921 Taylor Avenue, Marshalltown, IA50158

Phone:(641)753-9046;Fax: (641) 753-6812;Email:

See us on the web at:

ADOPTION APPLICATION

Please provide complete and accurate information. Failure to provide requested information will delay the application process.

There may be multiple applications on the same pet, in which case we will choose the most qualified.

We are not able to tell you if there are other applications on a particular pet.

**You must be at least 21 years old to adopt an animal from this facility**

Applicant Information- Please PRINT all information
Name 1: / DOB: / Drivers License#:
Name 2: / DOB: / Maiden Name:
Street Address: / State: / Phone 1:
City: / ZIP: / Phone 2:
County: / Phone 3:
Employer Name & Contact Info: / Email:
Residence Information- Please PRINT all information
Do You: Own / Rent / Live with Family Who Owns Home (Please Circle which best describes your situation)
Landlord/Property Owner Name & Phone:
Are Pets Allowed? / Have You Contacted about Adopting a Pet?
Type of Residence: / Length of Time at Current Residence:
Does your home owner or renter insurance allow/cover the type/breed of animal you are applying for?
Household Information- Please PRINT all information
Names and Birth Dates of Adults Living at Residence:
Names and Birth Dates of Minors Living at Residence:
Who Will be the Primary Caretaker?
Is everyone living in the home in agreement about adopting and caring for this animal?
Animal Care Plan- Please PRINT all information
Pet Will Be: Indoor, Indoor/Outdoor, Outdoor? (Please Circle Which Best Describes Your Situation)
If outdoor, what type of housing/containment do you have?
How Will the Pet Be Exercised?
Do you understand the costs, challenges, and care required for the animal you wish to adopt?
Are you prepared to spend $700, on average, per year on a new pet?

Shelter staff only:

BC fileHome

RTO fileLandlord

DNA fileICOnline

Vet Ref

ApprovedDeniedConditional

CalledNotes:

Animal Ownership- Please PRINT all information
Please List Pets You or Your Family Currently Own
Pet Name / Pet Type / Age / Sex / Altered / Owner Of Record / Vet / Vet Phone
If Any Pets are Unaltered or Have Incomplete Vet Records Please Explain Why:
Pets You No Longer Own
Pet Name / Pet Type / Age / Sex / Altered / Why Pet Is No Longer Owned / Vet / Vet Phone
Previous Adoption History- Please PRINT all information
Have You Ever Applied for Adoption with the Animal Rescue League of Marshalltown Before?
If so, when?
Have You Ever Been Declined for Adoption from us or another rescue group/shelter?

Questions- Please PRINT all information

Do you understand and agree to comply with all local, state, and federal laws regarding pet ownership?

Have you or anyone in your household been charged with any type of assault?

If so who and when?

Have you or anyone in your household been charged with animal abandonment, animal cruelty or animal neglect? ______If so who and when?______

Occasionally we require an inspection of the home and living environment prior to adoption? Do you agree to allow a ARL representative to visit your home, if it becomes necessary during the application review process?______

I hereby certify that the above information provided is accurate to the best of my knowledge. I understand that any false information will automatically result in the denial of my application. I authorize the Animal Rescue League of Marshalltown to check all information provided to determine its accuracy, which includes but is not limited to current and previous vet records, home ownership, rental agreements, and public records.

Applicant Signature______Date______

The Animal Rescue League of Marshalltown reserves the right to deny any adoption application for any reason.