Your name:*
Your email address:*
Address:*
State:*
 Zip:*
City:*
Phone number:*
 Cell number:
Best time to call:
 Are you over 18?:
 Yes:
No:
Are there any children in your home?:
 Yes:
No:
 If so, how old are they?:
Does your family have any pet Allergies?:
 Yes:
No:
 Yes:
No:
Have all family members agreed to adopt a pet? :
Do you rent or own your home? :
 Rent:
Own:
 Is your yard fenced?:
 Yes:
 No:
Do you have pet restrictions from a landlord or HOA? :
 Yes:
No:
 If yes, please explain:
Driver's license number:*
 State:*
Name of pet you are applying for:*
 If unavailable name of second pet:*
Do you have any pets in the home right now?  If so, please tell us about them. If no,
please tell us about the last pets you have had:
Species:
 Breed:
Do you still have this pet?
 Yes:
 No:
Name:
 Age:
If no, why not:
When/Where did you get this pet:
For dogs/cats only:
Is this pet sterilized?
 Yes:
 No:
If no, why not:
Species:
 Breed:
Do you still have this pet?
 Yes:
 No:
Name:
 Age:
If no, why not:
When/Where did you get this pet:
For dogs/cats only:
Is this pet sterilized?
 Yes:
 No:
If no, why not:
Your Veterinarian’s Info:
Clinic Name:*
Doctor:*
Clinic Phone Number:*
Please tell us more about yourself, your family and any stories you would like to share with me
I certify that the information I have provided is accurate and truthful.  I
understand that not every applicant will be a good match for a pet, and that I
will be notified if the adoption committee feels I will be a good match. By
clicking Submit below I am signing my application electronically.:
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Whipstaff Rescue Adoption Application
* Required fields.  Please be sure to complete all required fields.
Continuous use of this application form to submit illegitimate information will be reported as harassment.