Adoption Application

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 animal you are interested in?

What type/breed of animal is he/she?

Applicant's Name:

Co-Applicant's Name:
(Adopters over the age of 70 are required to have a co-adopter in case of accident or death).

Street Address:

City, State, Zip:

Home Phone:

Cell Phone:
E-mail Address:

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?

List all people living in your home and their ages - include yourself please:

Do you have children that visit or live next door? If yes, please list ages.

How long have you lived at your current address?

Do you plan on moving within the next year? If yes, what will you do with your new 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?
No
Yes

Is shedding a concern?
No
Yes

Is noise a concern?
No
Yes

Is scratching a concern?
No
Yes

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

What other pets do you have? (Type and sex)

Where do your current pets sleep?

Is your current pet(s) spayed or neutered?

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

If your current pet is a dog, is he/she on heartworm preventative?

Are you willing to have a home visit prior to the adoption?

Do you travel a lot?

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

Under what circumstances would you have to give up your 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 your new pet?

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

How will you correct inappropriate behavior?

If necessary, are you willing to housetrain/litterbox train your new pet?
No
Yes

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

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?
No
Yes

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

You live in a:
House
Townhouse
Condominium
Apartment
Mobile Home

If you rent, do you have permission from your landlord to have a pet?
Yes
No
I don't rent

A volunteer will be contacting your landlord. Are you ok with this?
Yes
No
I don't rent

Landlord's Name:

Landlord's Phone Number:

Where will you keep your new pet during the day while you are home?

Where will you keep your new pet while you are not at home?

Where will you keep your new 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?
 No
Yes

If for any reason you are not able to keep the pet, are you willing to
return him/her to Animal Rescue of Tidewater?
No
Yes

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?
No
Yes

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

Will this be your first pet?
No
Yes

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

Pets can live 12-15 years, even longer depending on the breed and size.
Can you commit to caring for them for this period of time?
No
Yes

Section 2 - If this is not your first pet, list the pets you have owned in the last five years.
Please provide a vet reference if different from your current vet.

Pet's Name:

Type of animal:

Breed:

Years in home:

Reason for death/leaving:

Vet Reference:


Pet's Name:

Type of animal:

Breed:

Years in home:

Reason for death/leaving:

Vet Reference:


Pet's Name:

Type of animal:

Breed:

Years in home:

Reason for death/leaving:

Vet Reference:


Pet's Name:

Type of animal:

Breed:

Years in home:

Reason for death/leaving:

Vet Reference:


Pet's Name:

Type of animal:

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?
No
Yes

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
Gift
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? If yes, please describe height and fencing type.

Are you willing to reinforce/repair your fence if needed?

If your yard isn't fenced, is there a fenced in area nearby where you can regularly exercise your dog?

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?
No
Yes

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?
No
Yes

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 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:

Current 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):


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.

Current Duty Station:

How long will you be in the Military?

Do you live in base housing?

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?

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?

If so, when and where will you locate?

Did you have pets at your last station?

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.