Star Bright Animal Rescue

Adoption Application

ADOPTER’S INFORMATION:

Application Date:
Name:
Occupation:
Name:
Occupation:
Street Address:
City, State, Zip
Home Phone:
Cell Phone:
Work Phone:
Email:

HOUSEHOLD INFORMATION

How did you hear about us?
How long at Present Address: / Own or Rent? (If rent, please provide name, address, and phone no of landlord.
Please list all adults living in the home and their ages (including yourself) :
Please list all children living in the home and their ages:
Fence - How high and what is it made of (chain link, stockade, invisible):
Do you have other dogs? Y N
Please complete the following for each dog Name/Age/Sex/Altered/Dominant:
Do you have cats?Y N / Explain:
Other animals? Y N / Explain:
Have you owned a dog as an adult before?
Y N
If yes, what brand of heartworm preventive did you provide your dog? / When?
Breed:
What happened to that dog?

VETERINARY INFORMATION

(If you do not have a vet now, please provide name and contact information of the vet youare planning to use with your new dog).

Name of Vet:
Business Name:
Address:
Phone:
Please list (3) personal references- Relationship, name & phone no:
Personal Reference (1)
Personal Reference (2)
Personal Reference (3)
Why do you want to adopt?
What is your work schedule?
How long will your dog be alone?
Where will the dog be when alone?
Where will the dog be at during the day?
Where will the dog be at night?
Exercise Plan, please explain:
When out of town:
Do you have experience with crate training?
Have you ever taken a dog to obedience training?
Would you be willing to do this?
Are you willing have a Star Bright volunteer visit your home by appointment?
Ideal dog (Color/Gender/Age/Activity/Mix?):
Notes (please use this space to tell us any additional information and/or which dog(s) you might be specifically interested in):

ACKNOWELDEMENT:

I have read the adoption policies and will agree to abide by these terms if selected to adopt a dog from Star Bright Animal Rescue, Inc. I also agree to allow Star Bright. to contact my vet or any of the people listed as references on this application to discuss the information listed herein. I have answered the above questions truthfully and to the best of my ability. I also understand that Star Bright Animal Rescue, Inc. may refuse or deny my application for adoption on any grounds. I understand that if I am e-mailing this application, my e-mail is my signature. Further, my signature below indicates that I am at least 21 years of age and intend to be the legal owner and the person responsible for the care and well being of any dog I adopt from Star Bright Animal Rescue, Inc.

Date:
Print Name:
Signature:

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