PROMISED LAND ANIMAL RESCUE
1611 Rocky Hollow Rd Atkins, VA 24311
(276) 686-8522
promisedlandanimalrescue.com
ADOPTION APPLICATION
The following information is requested so that we can assist you in the selection of a new pet. Our goal is to place animals in loving homes with compassionate people who will make lifelong commitments to them by accepting them as a member of their family. The consultation process is designed to help determine the best compatibility “match” between the pet and adopter(s) lifestyle. This also enables us to determine if the adoption is in the animal’s best interest.
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NAME HOME PHONE
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ADDRESS CELL
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CITY/STATE ZIP EMAIL
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EMPLOYER WORK PHONE
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DATE OF BIRTH TODAY’S DATE
Name of animal you are interested in adopting _____________________________________
How did you find out about Promised Land Animal Rescue? ______________________
What are your reasons for adopting a pet? __Family Pet __For Children __Gift __Companion for pet
__Working/Farm __Protection for home __Protection for business
1. Housing: Own___ Rent___ How long at this address? ________________
House___ Townhouse___ Apartment/Condo___ Trailer___ Other___
2. Do you have a yard? Yes ___ No ___ Size: ____________________
Fenced? Yes ___ No ___ Type: ____________________
3. Name/phone number of landlord_________________________________________________________
4. Are you planning to move anytime soon? Yes ___ No ___ If yes, when? _____
5. Your household consists of: Adults only ___ Live alone ___ Family w/children
Ages: ____________________________________________________________
6. The activity level in your home is: Quiet ___ Active ___ Hectic ___
7. Is there anyone home during the day? Yes ___ No ___ Hours at home: ______
8. In a 24-hour day, how long will the pet be left alone at any given time? 4 hrs ___ 4-8 hrs ___ 8-12 hrs ___ 12 hrs or more ___
9. Where will your pet primarily be living? Inside ___ Outside ___
10. Where will your pet sleep at night? ____________________________________
11. Where will your pet stay when you are not at home? Loose in house ___ In crate ___ Fenced yard ___ Garage
___ Electric Fence ___Basement ___ Other _____________________________
12. Does any member of the family have allergies to animals? Yes ___ No ___ Who? ______________________________________________
13. Who will be the primary caregiver of your pet? ___________________________
14. Have you ever surrendered a pet to a rescue organization? Yes ___ No ___
15. Please check one: First time pet owner ___ Had pets growing up ___ Have always had pets ___
16. Are you familiar with: Crate training ___ Causes of heartworm disease ___ Feline Leukemia ___
17. Do you plan to take your dog to obedience classes? Yes ___ No ___
18. Will you have your pets: Declawed ___ tail docked ___ ears cropped ___
19. Average annual cost for pet ownership can meet or exceed $350 for a dog and $250 for a cat. Boarding costs, illnesses, and injuries can be additional. Have you considered this addition to your budget & the impact it will have in your family and lifestyle? Yes ___ No ___
Tell Us About Your Pets
Current Pets in Household:
Name Type Breed Age Sex Neutered? Kept in/out/both How long owned________________________________________________________________________________________________________________
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Please tell us about any other pets you’ve had in the past 5 years which you no longer have:
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Name Type Breed Age Sex Neutered? Kept in/out/both What Happened?
Who is your veterinarian? _______________________________________Phone#:______________________________________________
Please Tell Us What You Are Looking For In A Pet
1. I am looking to adopt a Dog ____ Cat ____
2. Pet Selection Preferences:
Sex: Male ____ Female ____ No Preference ____
Age: Puppy/Kitten ____ Teenager ____ Adult ____ No Preference ____
Size ( Dogs Only): Small ____ Medium ____ Large ____ No Preference____
Activity Level: Very Active ____Semi-Active ____Calm ____ No Preference___
3. Please note any qualities or traits desired ______________________________________________________________________
4. Do you have a specific amount of time in mind for adjustment?______________________________________________________
5. For what reasons do you feel you might need to return an animal?___________________________________________________
6. Do you have any questions or concerns? (Please list)______________________________________________________________________________________________________
7. If the adoption counselor feels that the animal you picked out is not a good match for some reason, would you consider another? _____________________________
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Signature Date Adoption Counselor