Pet ownership is a serious responsibility It is the policy of Animal Rescue of Tidewater to assure that each person who adopts a pet is not only aware of that responsibility, but also capable of and willing to accept the responsibility morally, physically and financially.

The following questionnaire has been designed to help both you and Animal Rescue of Tidewater decide if you and/or your family are indeed adequately prepared to assume the type of responsible ownership we are endeavoring to assure for our adoptive pets.

SECTION 1 - Questionnaire

What is the name of the pet you are interested in? (required)

What type/breed of animal is he/she? (required)

Applicant First and Last Name (required)

Your Age (required)

Street Address (required)

Suite, Condo, Apt.

City (required)

State (required)

Zip (required)

Phone Numbers - Home and cell (required)

Your Email (required)

(Adopters over the age of 70 are required to have a co-adopter in case of accident or death).

Co-applicant First and Last Name

List all people living in your home and their ages.. Enter none if you live alone.

Place of employment (Applicant)

Title / Department (Applicant)

How long have you been there? (Applicant)

Do you plan on changing jobs soon? (Applicant)

Business phone (Applicant)

Place of employment (Co-Applicant)

Title / Department (Co-Applicant)

How long have you been there? (Co-Applicant)

Do you plan on changing jobs soon? (Co-Applicant)

Business phone (Co-Applicant)

Best Time to Call

Where did you hear about us?

Do you have children that visit or live next door?
 Yes No

If yes, please list ages.

How long have you lived at your current address?

Do yo plan on moving within the next year?
 Yes No

If yes, what will you do with your animal?

Why do you want a pet?

Please check all that describe your lifestyle:
 Homebody Social Butterfly Active Outdoors Have lots of visitors Workaholic

Does anyone in your family have allergies?
 Yes No

Are there shedding concerns?
 Yes No

Are there noise concerns?
 Yes No

Are there scratching concerns?
 Yes No

Who will be responsible for the care and cost of your new pet?

What other pets do you have?

Where do your current pets sleep?

Are your current pet(s) spayed or neutered?
 Yes No

If your animal(s) is/are not altered, please tell us why?

If current pet is a dog, is he/she on heartworm preventative?
 Yes No

Are you willing to have a home visit?
 Yes No

Do you travel a lot?
 Yes No

Who will take care of your pet when you do travel?

Reason for giving up pet?
 Moving New Baby Divorce Pet Behavior Pet Becomes Sick Other None

If you checked behavior or other, please explain:

How do you plan to train new pet?

Who will be responsible for the training of your new pet?

How will you correct inappropriate behavior?

Are you willing to housetrain/litterbox train pet?
 Yes No

If the adoption counselor believes it is necessary to purchase a dog crate/cat container, will you do so?
 Yes No

If you checked no, please explain why not:

Do you understand that your new pet will need periodic grooming to include:
brushing, trimming nails, ear and teeth cleaning?
 Yes No

Approximately how many hours a day will your new pet be left alone?

What do you live in:
 House Townhouse Condominium Apartment Mobile Home

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

If you rent, a volunteer will be contacting your landlord. Are you ok with this?  Yes No

Landlord's Name

Landlord's Number

Where will pet be during the day while you are home?

Where will pet be while you are NOT at home?

Where will you keep pet at night?

Are you willing to keep a collar with a tag bearing your name, address, and phone number on your pet at all times?
 Yes No

If, for any reason, you are unable to keep your pet, are you willing to contact Animal Rescue of Tidewater ASAP?
 Yes No

Are you willing to accept immediate and full responsibility for the ownership of your adopted animal, including all health care costs and necessary burdens and responsibilities of owning a pet?
 Yes No

Do you understand your pet will need annual veterinarian examinations and annual vaccinations?
 Yes No

A volunteer will be contacting the vet(s) indicated on this application. Are you okay with this?
 Yes No

SECTION 2
If this is not your first pet, list the pets you have owned in the last five years. Please list the following for each pet:
Name, Type, Breed, Years in Home, Reason for death/leaving, Vet Reference

SECTION 3

Complete this section if you are adopting a dog. If adopting a cat, skip to Section 4.

Do you understand dogs need to be checked annually for heartworms and continue on monthly heartworm preventative?
 Yes No

What are your reasons for adopting a dog?
 Watchdog Breeding Hunting Child's pet Guard dog for business Guard dog for home Companion for other pet Companion for self/family Other

When outside, how do you intend to keep the dog confined to your property?
 Leash Fenced yard Fenced pen Chain / Tie out Run loose Other

Describe the temperament and activity level that you are looking for in a dog.

How will you exercise your dog?

Do you have a fenced in yard?
 Yes No

If yes, please describe height and fencing type.

Are you willing to reinforce/repair your fence if needed?
 Yes No

If your yard isn't fenced, is there a fenced in area nearby where you can regularly exercise your dog?
 Yes No

If yes, please describe the fenced in area and its size:

How much time do you think it will take a dog to adjust to his/her new environment?

What is it about this dog that drew you to him/her?

What bad habits will you not be able to tolerate or manage?
 Jumping up  Barking  Pulling on the leash Separation anxiety Chewing Digging Play biting Rough play Not being housebroken Other

Are you considering taking your pet to formal obedience class?
 Yes No

SECTION 4 - Fill out this section only if you are adopting a cat. If adopting a dog, skip to Section 5.

What are your reasons for adopting a cat?
 Breeding Hunting mice/rodents Child's pet Companion for other pet Companion for self/family Gift Other

Do you plan on declawing your cat?
 Yes No

Check all that describe the temperament / activity you are looking for in a cat?
 Kitten-like / High energy Outdoor cat Lap cat Mellow Very affectionate Quiet Responsive Talkative Independent

How long do you think it will take for a cat to adjust to his/her new environment?

SECTION 5 - All applicants must fill out this section. Please list two references that you have known for more than two years and who can speak to your ability and commitment to providing a long-term, loving home for your new pet. If you do not have a current vet, you must provide a third reference.

Vet Reference
Current Vet's Name

Vet's Phone Number

Current Vet's Address

Personal Reference 1
Name:

Address:

Phone Number (Day):

Phone Number (Evening):

Personal Reference 2
Name:

Address:

Phone Number (Day):

Phone Number (Evening):

Personal Reference 3 (Only needed if you don't have a vet reference.)
Name:

Address:

Phone Number (Day):

Phone Number (Evening):

Section 6 - Please complete the following if you or your spouse is in the Military. If not in the Military, skip to Section 7.

Duty Station:

How long will you be in the Military?

Do you live in base housing?
 Yes No

How long have you been stationed here?

How much longer will you live here?

Do you or your spouse have to complete a tour of duty over seas?
 Yes No

If yes, where will you be stationed and when will that take place?

What will you do with your pet if you ARE transferred over seas?

Are you expecting a state-side transfer?
 Yes No

If so, when and where will you locate?

Did you have pets at your last station?
 Yes No

If yes, where are they now?

SECTION 7 - Please let us know of any other comments or concerns you have?

NO GUARANTEES OR WARRANTIES OF HEALTH OR TEMPERAMENT CAN BE OR ARE MADE BY ART. ART is a private, non-profit organization operation almost totally from the charitable contributions of individuals and businesses in the community. Adoption fees DO NOT cover the cost of caring and sheltering the animal you want to adopt. ART will not be responsible for any medical care required by an animal adopted from us. You may return an animal for health reasons but a refund on the adoption fee WILL NOT be given unless the return occurs within the first two (2) days following the adoption and your veterinarian had advised us of a medical condition identified during that two (2) day period. We hope this information doesn't discourage you from adoption from us but reminds you that love comes with no guarantee. Anyone who adopts a dog or cat from an animal Shelter, Rescue agency or Humane Society is required by law to have the animal sterilized if it hasn't already been done. Anyone who violates this requirement is subject to civil penalties and may be required to meet their legal obligations under sections 301-796.126:1 et seq of the Code of Virginia.

By submitting this form, I certify that I understand that submitting an application does not guarantee that I will receive approval to adopt a pet from Animal Rescue of tidewater.

By submitting this form, I certify that all information on the ART Adoption Application is true and correct.