Adoption Application

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Requested Animal

Please note that our adoption fee is a minimum of $250.00

First Name Last Name
Address City
State ZIP Code
Email Confirm email

Please list all members in your household and ages:

Name
Age

Please list all pets owned in the last 5 years

Name
Breed
Years Owned
Age
Living with you?
Altered?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

If you have owned more than 4 pets and need more space, please list the information requested above below.


Vet info (must be completed in full)

Veterinarian's Name Phone Number
Veterinarian's Address City
State ZIP Code

IMPORTANT! Some vets require you to provide verbal permission before records are released to us. PLEASE CONTACT YOUR VET & ADVISE THAT ELEVENTH HOUR RESCUE WILL BE CALLING FOR A "VET CHECK" AND PROVIDE YOUR PERMISSION.

If you have taken your animals to more than one vet, then we need to have the name, phone number and address of all the other vets your animal has received treatment with:

If you have never owned a pet or if your last pet has been deceased longer than 5 years, please provide two references: One reference can be a family member. The second reference must be non-family, such as a coworker.

Name
Phone Number
Relationship to You

Do you own your home? Yes No
If renting, please list your Landlord's Name

and Phone Number

Do you have a Fenced Yard? Yes No
How do you plan on letting the dog outside?


Will you crate train the dog? Yes No
If no, where will the dog be kept when you are not home?


If you are applying for a puppy, please explain how you will train the puppy:

Please note that only FULLY completed applications will be considered. Once the application has been reviewed and approved or denied, you will be contacted via email or phone. Please check your email for the notification. You will be notified of the approval within 7-10 days providing that your application was complete in the information required.

If approved, you will be given the name and contact information of the foster family that has the interested dog. It will then be up to you to contact the foster family and arrange to meet the dog within your schedule and the foster family's schedule. An approved application does not guarantee the dog listed on the application. The approval does give you the opportunity to adopt any animal within our organization providing that we feel the animal is a fit for your family circumstances.

By clicking on the submit button below, I hereby give permission to the Eleventh Hour Animal Rescue to contact my veterinarian to obtain information about past and present pets. I also authorize the rescue to verify the above information. I do understand that the pet I adopt may need to be spayed or neutered.