Carolina Pet Rescue

Date MM / DD / YYYY
Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Phone Number * ### - ### - ####
List all pets owned within the last ten years. Name, breed, age, spayed/neutered and location kept. *
Veterinarian Information First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number ### - ### - ####
Name and ages of people in household (including adopter). *
What kind of home do you live in?
How long have you lived there?
Do you have landlord's permission?
Landlord's name and number if applicable.
Do you have a fenced yard?
How high is the fence?
Does it touch the ground?
If it has a gate, is it locked?
Who will be the primary caregiver?
How long are you gone each day?
Are you emplyed outside the home? Is so, how far is your job from home?
What kind of lifestyle do you want your new pet to have?
Indoor Outdoor only Indoor/Outdoor
Is there a specific dog in our program you would like to meet? List by name.
Where will the animal sleep at night?
How often do you travel?
When you travel, what arrangements will you have for pet care?
How will you exercise your dog and how often?
If you have children in the family how much responsibility will they have for the animal?
What will happen to the pet if you have children?
What will happen to the pet if you move?
What would you do if your pet developed behavior problems?
How do you plan to teach your pet?
Are you willing to take this pet to the vet annually or as needed?
Are you willing to provide flea and tick control monthly?
For dogs, are you willing to provide monthly heartworm preventive?
I am willing to make a 20 year commitment to this pet?
Reference name and phone number:
Do Not Fill This Out