First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Alt Email
Text/Pager Email
Name of dog(s) you are applying for.
Your date of birth:*
Full name of spouse/significant other (if none, write "none"):*
Their date of birth:
Length of time at current home:*
Do you intend to move soon? Choose all that apply: Yes No
Previous address if time at present address is less than 2 years (street address, city, state, zip):
Do you rent/lease or own your residence?
If you rent, the name and phone number of your landlord:
Name and address of employer:*
Length of time at this job:*
Total Yearly household income:*
List the names and ages of other human members of your household. If there are none, then write "none."*
Do you or anyone in your household have allergies or asthma?
If yes, explain.
Why do you want a dog?*
Are all members of the household "on board" with and excited about adopting a pet?
If no, explain.
How long will your pet be left alone without human companionship each day?*
Are you willing to be patient and take time to allow your new pet to adjust to you and your home?
Are you financially able to provide annual and routine pet care (exams/vaccinations)?
Are you able to make a LONG-TERM commitment to care for a dog?
Will your dog have access to all parts of the house?
If no, explain:
Do you have a fenced yard?
Will you take your dog for daily walks?
Do you intend to leave your dog outside for any extended amount of time?
If your answer was yes, please explain:
Do you want your dog to have puppies?
Are you willing to spend the time and (potentially) money to make sure your dog is adequately trained?
List all present and/or previous Veterinarian(s) used. Include phone numbers and addresses (advise your Veterinarian(s) that we will be calling—if they are aware, it will speed up the approval process). If none, then write "none."*
List all pets that currently live in your home: Pet's name, type (dog/cat/etc.), sex, state if spayed/neutered, inside/outside/both, age. If none, write "none."*
List all pets you have owned in the past five years that no longer live with you. Include pet's name, type, sex, whether spayed/neutered, kept inside/outside/both, and what became of the pet. If none, write "none."*
Please provide the names, phone numbers and relationship to you of at least two people. Do not use relatives. Excellent references are veterinarians and people who know both you and your pets. We will call the references in our approval process. For each, provide: Name, contact phone number(s), and their relationship to you.*
Application Completion does not mean that you are guaranteed adoption approval. A member of Purr-Fect Match will contact you once the references and veterinarian(s) have been contacted, and after a decision has been made. We appreciate your interest in our animal rescue. By choosing "yes" below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting a pet. I understand that Purr-Fect Match Animal Rescue has the right to deny my request to adopt an animal, and I understand that I authorize investigation of all statements in this application, including veterinary records. I certify my understanding of all of these things.
