Jerry's Rescues Adoption Application

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Complete this form to request approval for adopting a particular pet, or to request a certain type of pet from Jerry's Rescues. You will be contacted by email after this application has been reviewed.

Required entries are indicated in bold italic and are preceded by an asterisk.

*First Name:          

*Last Name:           

*Address:             

*City:                

*State:               

Zip Code:             

Email Address:        

Alternate Email Address: 

How often do you check your email? 

*Day Phone:           

*Evening Phone:       

Cell Phone:           

Best Times To Call:   

*Name of pet or type of pet you are applying to adopt:

*Why did you choose this particular pet or type of pet?

*Do you currently own any pets?

Yes
No

*Have you previously owned any pets?

Yes
No

Please provide current OR previous vet reference name/office:

Vet office phone number:    

Name on vet office account:

Please provide name(s) of pet(s) seen by this vet office

*Do you have children living with you?

No
Not living in home, but frequently visit
Yes

If there are children living in the home, or children that frequently visit, please check all age groups that apply:

Less than 2 years old
2 to 5 years old
6 to 10 years old
over 10 years old

*Do you have a fenced yard?

Yes
No
Will install fence

If no fenced yard, please indicate how you plan to exercise your pet:


*Do you own or rent?

Own
Rent

If you rent, do you have your landlord's permission to have a pet?

Yes
No
Don't know

If you rent, please provide your landlord name and phone number:

What attributes below are important for your pet to have?

Good with kids
Good with cats
Good with dogs
Good with livestock
Good with birds
Past chewing stage
Easy going
Not hyper
Does not matter
Other

If other was checked, please enter attribute(s) here:

Do you have an age preference? Please check all that apply

None
Baby (4 months or less)
Young (4 months to 1 year)
Adult (1 to 7 years)
Senior (over 7 years)

Do you have a gender preference?

Female
Male
No gender preference

Do you have a health preference? Please check all that apply.

Healthy only
Healthy with minor SHORT term problem
Healthy with minor LONG term problem
Disabled
Does not matter

What pre-training is desirable? Please check all that apply.

House trained
Basic obedience training
Advanced obedience training
Does not matter *Where will your pet sleep at night?
Pet will sleep inside at night
Pet will sleep inside at night in a crate
Pet will sleep outside at night
Pet will sleep elsewhere

If you chose Pet will sleep elsewhere, please enter where here:

What training methods would you use should behavioral issues be encountered with your adopted pet?:

Please provide any experience you've had with rescue pets

Why do you want to adopt a rescue pet?:

*Check any of the following you feel are valid reasons for giving away a pet:

Fleas
Too expensive
Chews or destroys household objects
Barks too much
Having a baby
Getting married or divorced
Moving
Sheds too much
Children will no longer take care of the pet
Got too big
Jumps on/scratches children
Digs in the yard/garden
Found a new place to live that doesn't allow pets or your dog's breed
Would never consider giving up pet
Other

If other was checked, please enter reason(s) here:

Would you be interested in volunteering?

Yes
No
Maybe

Would you be interested in making a donation, regardless of whether you adopt a pet from us?

Yes
No
Maybe

*I understand that if I am approved for adoption that I will be required to sign a legally binding adoption contract.

Yes
No

*I understand that I will receive an email acknowledging receipt and review of this application. I understand that I will be expected to reply to the email. I understand that if I do not supply a valid email address that I cannot receive an acknowledgement email. I also understand that it takes time for someone to review and process this application. I do not want to waste anyone's time and intend to acknowledge all emails. I am serious about adopting this pet.

Yes
No

If you have anything else you would like us to know regarding this application, please enter it in the area below.

Jerry’s Rescues has the right to turn down any application for adoption for any reason. By submitting this adoption application I agree that I will not hold Jerry’s Rescues responsible for any liabilities involved with the adoption of any animal and am admitting that all information on this application is true to the best of my knowledge. I understand my application can be rejected by Jerry's Rescues if it is found to contain false information.