Adoption Approval Form

Your Name

House Number, Street
City
State
Zip
Email
Phone Number with area code
Alternate Phone Number with area code

Is there a particular pet that you are interested in?

How did you hear about West TN Animal Rescue?

Are you willing to take the time with the acquisition of this breed of animal, read and learn all the facts of temperament, socialization, proper handling, and understand the time required to bring out the full potential of the breed? Yes No

Do you want a: Male Female Either

Will this pet be an: Inside Outside

If no one is home during the day, what will you do with your pet?

What will you do with your pet while you are out of town on business or vacation?

What will you do with your pet if you have to move?

Have you ever owned a pet? Yes No
If the answer is YES, and you no longer have the pet, please tell us how long you owned your pet and what happened to the pet.

Do you currently have pets? Yes No
If you answered YES, please list type of pet, age, dispositions, if they are spayed or neutered, and up to date on vaccines

Do you consistently use heartworm preventative for your animals throughout the year?
Yes No

If so, what type?

Please list the number of people in your household and their ages.


Does anyone in your household NOT want a new pet? Yes No

Your Home: Own Rent

If you rent, do you have permission from your landlord to have a pet? Yes No

Please provide your landlord’s name and phone number for confirmation.

Is your yard fenced securely? Yes No

Do you have a pool? Yes No

How do you plan to insure your pet’s safety outdoors?

What will you do if this pet has behavior problems? i.e. chewing, not house broken, demanding lots of attention, etc.

How much time would you give your new pet to adjust to you and its new home?

What will you do if this pet becomes ill or injured and requires expensive medical attention?


What will you do if this pet becomes lost?

Do you currently have a vet? Yes No

If yes, please provide the vets:
Name
Phone

May we contact this vet for references? Yes No

Please provide the names and contact information of three personal references.

Would you be willing to allow us to visit your home? Yes No

(Electronic) Signature:

Date

By filling out this application for adoption, you agree to allow West TN Animal Rescue to check the references provided. You further agree that if you are unable to keep this pet for any reason, the animal must be returned to West TN Animal Rescue. We ask that you give us enough time to find a foster home for the animal before returning. In the event the pet is returned your adoption fee is non-refundable. Thank you for your cooperation. This comprehensive questionnaire helps us to try to place the right pet with the right family. An improper placement or one in which all the details are NOT known can end tragically, usually for the animal.

Shannon Dykstra
P.O. Box 54
Holladay, TN 38341