All Creatures Great and Small Rescue

ACGSR, Inc.

Post Office Box 904

Hollister, CA 95024

PHONE 831/917-5570

Adoption Application

Please provide the following information to assist us in matching the right pet to the right home. In orderto process the adoption, this form must be completed, reviewed and then approved. Adoption Fee for Felines is $135 andCanines fee is $275. Adoption Fee includes Veterinary Health Examination, Vaccinations, Deworm, HeartWorm / FEL/FIV Testing, MicroChip, Advantage/Frontline Applied.

Pet you are applying for
Name
Address
City / State / Zip Code
Home Phone / Work Phone
Email
Driver’s License & Issuing State
Do You Rent? / Homeowner? / Years at This Address?
If You Rent Are Pets Allowed? / Number Allowed / Type
Are there any breed restrictions?
Landlord’s Name, Address & Telephone Number
If you rent verbal or written approval by the landlord is necessary prior to approving any adoptions.
Access to the information will expedite the process.
Number of Children Living in the Home? / Ages
Does Anyone in The Home Have Allergies? / Cats? / Dogs?
Are You Adopting This Pet For Yourself?
Pets: Please list all the animals that you currently have or have previously owned. If you no longer have the pet, please explain why on the back of the application what happened to the pet.
Type of Pet / Age / Sex / Spayed/Neutered / Indoor/Outdoor
Who is your Vet? / Vet Phone
Vet Address
Have you ever surrendered a pet to a Shelter/Rescue? / YES / NO
If yes, please give details, including address & phone number of the Shelter/Rescue

Canine Adoption Only

Why are you interested in adopting this particular dog or puppy?
Where will your dog be housed when left unattended?
Is your backyard fenced? / Fence Height? / Fence Style?
Do you have a pool/spa? / Is it enclosed? / How?
Do you have a balcony? / Rail Spacing? / Where?
If yes, will you reinforce or enclose the areas if we request? / YES / NO
Will you put a lock on your gates if we request? / YES / NO
Where will your dog sleep?
Who will care for your pet if you have to work / vacation?
How many hours a day your dog/puppy will be left alone?
If you are a adopting a puppy, do you know how to house train it? / YES / NO
Are you willing to take your dog/puppy to obedience classes? / YES / NO
If your dog has a barking problem, how will you handle it?

Feline Adoption Only

If you are interested in adopting a cat/ kitten (s), these must be kept indoors, are you prepared to do this?
Who will care for your cat/kitten if you must work?
Where will your cat/kitten sleep?
A newly adopted cat must be kept in a safe room in the house until it becomes comfortable for about 1-2 weeks.
Which room will you keep your cat/kitten in?
Will this be problem?
We do not approve of cats/kittens being outside; will this be a problem for you? / YES / NO
If yes, Please explain.
Cats naturally scratch. How will you handle this?
Would you ever consider getting your cat declawed? / YES / NO
If yes are you aware of the pain your cat will go through? / YES / NO
Would you consider other methods if we gave you options? / YES / NO

All Pet Adoptions

Who will be the primary caretaker of your new pet?
How much are you willing to spend in veterinary costs for your new pet, Not including annual checkups or shots?
Will you teach your children to respect the boundaries of your new pet?
Will you allow your new pet (s) to be a part of your family?
Adopting a pet is a 10-15 year commitment. Are you willing to make this commitment?
If approved, ACGSR, Inc. reserves the right to do a home visit prior to placement.
Do you have any objections?
If you moved, what would you do with your pet (s)?
In order to assist us with the adoption we would like to know about yourself and your family,
And why youareinterested in adopting a pet today?

I certify that the above information is true to the best of my knowledge. Any false information will result in the return of the pet I have been approved to adopt, and will void any adoption agreement that I have with ACGSR, Inc.

______

Signature Date

ACGSR, Inc. reserves the right to refuse an adoption to any person (s), without having to disclose the reason for the refusal. ACGSR, Inc. is here to serve in the best interest of the cat or dog, and not for the benefit of any person or group.

Approved / Denied
Comments
Adoption Coordinator / Date

All Creatures Great and Small Rescue

ACGSR,Inc., A Non-Profit 501 (c) (3) Corporation

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