Jessamine County Animal Shelter

Dog/PuppyApplication

AdoptionApplicationfor: (Pet’snameornumber)

PersonalInformation

Name:

Address:

City: State: Zip: Apt #: Phone: AlternateNumber: Driver’sLicenseNumber: _

AlternateContactandphonenumberformicrochip: _

PersonalReference:Phone:

Relationship toReference: Areyou:□working□retired□ attending school: □homemaker other: Employer’sname: Howlonghaveyouworkedhere?

Age range:(please check one)□under 18 □18-23 □24-29□30-50 □50-65 □65-70 □70-over

Household Information

Is your home a (pleasecheck)□house □apartment □duplex/condo □trailer □farm

Do you:□rent□own□lease? How long have you lived at thisaddress? If you do not own, landlord’s name and phonenumber: Howmanyadultsliveinyourhousehold: Howmanychildren: ages: Doesanyoneinyourhouseholdhaveknownpetallergies? Aretheyonmedicine? Doyouhaveafencedinyard? Ifso,whattypeoffencingandhowtall?

Pet Information

Doyoucurrentlyownotherpets?Totalnumberofanimalsinhousehold:_ pleaselistALLpetsyoucurrentlyhaveorhavehadinthepast2years:

Areallpetscurrentlylivingwithyouuptodateonallvaccinations?

Do you use preventative treatments such as heartworm, flea and tick control? □ Yes □ NoType/Brand:

Who is your current veterinarian? Phone: address: city: state: zip: What owner’s name are records listed under:

Do you object to a vet reference call: □Yes □No?

To ensure that this adoption is in the best interest of both you and the dog/puppy you’ve selected, we ask that you answer the following questions:

Please describe the temperament you are looking for in a dog. Check all that apply. □High Energy/Active□Outdoor Dog □Lap Dog □mellow □Affectionate □Quiet Are you familiar with crate training?□Yes □ No

Will you use a crate?□Yes □ No How often?

Have you ever done obedience training with a dog?□Yes □No

Are you considering it with this dog? □Yes □No

Where will your pet spend most of its time?□Inside□outside □barn□crate other:

How many hours a day will your pet be left alone?

Where will your pet stay while alone?

Where will your pet sleep at night?

What attracted you to this particular dog/puppy?

How will you exercise your dog?

Where will your pet be kept if you go out of town?

The dogs and puppies available for adoption come to rescue in a variety of ways, but they all have one thing in common: they need loving and permanent homes. All canines have their health strictly monitored while in the care of NO PLACE 2 GO RESCUE, INC.However, due to the stressful situations under which many of these arrive, there is always the chance an animal is incubating a disease without showing clinical signs. We recommend a visit to your veterinarian within seven(7) days of the adoption date.

NO PLACE 2 GO RESCUE, INC.believes these canines to be in good health, but does not guarantee the health of any canine or assume any financial responsibility for future veterinary costs.

When adopting a dog/puppy from NO PLACE 2 GO RESCUE, INC., we expect you to make a lifetime commitment to the care of this canine. If, however, you ever find yourself unable to properly care for this animal, we ask that you agree to make every effort to return it to the NO PLACE 2 GO RESCUE, INC.

While it is the intent of the NO PLACE 2 GO RESCUE, INC., to find permanent, loving, stable, and responsible homes for all rescue animals, we do reserve the right to refuse adoption and will make the choice as best possible fit for loving lifetime home.

By entering your name in the field below, you agree that the information provided on this application is correct to the best of your knowledge and that you have read and agree to all statements above. Anyone who misleads or fails to provide accurate information will be denied all future adoption rights.

Applicant’s SignatureDate

Co-Applicant’s SignatureDate

*staff use only*

Date reviewed: □approved or □deniedif denied, why?

Adoption Counselor:

Vet Appointment On:

Vet Clinic: □AHON □McCaw’s other:

Paid Adoption Fee paid: $ □Credit Card □Check #: other:

Follow Up Call Date: Microchip #: by: