First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone

Cell Phone

Alt Email

Do you text? (are you able to receive texts at above listed number?)

PLEASE CHECK YOUR EMAIL SPAM FOLDER AS INITIAL CONTACT WILL BE SENT VIA EMAIL

Which animal are you interested in
Choose an animal: *Odie-Special Needs Senior *Pasta 4 Paws Pasta Dinner *Pasta 4 Paws Pasta Dinner Beau The Barbarian - DNA tested Biscotti - Cookie Crew Francine & Marmalade Koco Marilyn-happy girl Moose Mr. Kiki Reuger - Puppy Power Sadie-Dedicated and Loyal Sahvi Shortbread - Cookie Crew Snickerdoodle - Cookie Crew Sugar Wesson - Adorable Puppy Eyes

Are there any other of our pet(s) are you interested in adopting?*

What traits are you looking for in a pet

Are there any other traits that you are looking for in your new pet?*

Describe the energy level you would like in your new pet*

What, if anything, have you done to familiarize yourself with the breed(s) of the pet you are interested in and its traits, specific needs, etc?*

Are there any issues with your new pet that you are unwilling to work with? *

What is your age*

How many people reside in your household*

What are the ages of all others in the household?*

Are all the adults in the house hold agreeable to adopting a new pet? (we will need to speak to other adult members in the house hold)

Who in the household will care for the pet*

If there will be young children around this pet, please describe their previous experience with pets.*

Will this pet be a gift?*
Choose one: Yes No

What is your occupation*

Who will be financially responsible for this pet?*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

How much time will the animal spend alone during the day*

Where will the animal be kept when you are not home*

Where will the animal be kept when you are home*

Where will the animal sleep*

Describe how you will train the pet:*

Describe how your pet will get exercise*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Fence with openings (not completely enclosed) Yard Completely Fenced (completely enclosed, no opening at driveway) Back Yard Completely Fenced (completely enclosed, no opening to driveway) Part of Yard Completely Fenced (completely enclosed area)

What type of fence
Choose one: Privacy Chain Link Invisible Electric

What is the height of the fence

If you do not have a fence, how do you plan on containing your pet while he or she is outside?

How long have you lived at your current residence?*

Are you planning on moving soon?*
Choose one: Yes No

Home ownership - do you:*
Choose one: Rent Own Other

If Other, please explain (for example, live with parents, home owned by relative, etc)

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number, enter NA if not applicable*

Have you ever given up a pet? If yes, please explain*

Do you currently own any dogs? If so, please list their name, age, and breed

Please list the names and types of each dog you have owned in the last 5 years and what happened to them

Do you currently own any cats? If so, please list their names and ages

Please list any additional pets living in the household (dogs or cats not owned by applicant or other species not already mentioned)

For cats only: Are you planning to declaw
Choose one: Yes No

Is your pet? (check those that apply)

Please list the veterinarian's name, office name, and phone number for current or past pets or N/A if not applicable*

If you have used more than one vet for your current or past pet(s), please list the contact information (veterinarian(s) name, office name, and phone number)

List the name of the person (owner) vet records will be listed under:

Have you adopted a pet from us before?

If you have adopted from us before, tell us about it. Who did you adopt? How long ago? Dog or cat? Do you still have this pet? If you have not adopted from us before, please enter NA*

Have you applied to Rose's Rescue before?

If you have applied to adopt from us before, what happened? If you have not previously applied with us, enter NA.*

Why are you interested in adopting a pet at this time*

List at least two references (one of whom is not a family member) and their contact information. Name, phone number, email address:*

How did you hear about us (If internet, please be let us know what website if possible)*

Any additional comments you wish to add

I understand that a RR volunteer will be trying to contact me in the next several days and will be keeping an eye on my email or spam folder or text message for further communication in regards to this application.

I certify that the information entered on this application is true and accurate to the best of my knowledge. Please sign and date.*