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Adoption Application
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Name
*
First
Last
Pet name
*
Birth Date of Applicant
*
Home Phone
*
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United States
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United Kingdom
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Afghanistan
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Albania
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Algeria
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American Samoa
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Andorra
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Angola
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Ascension Island
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Austria
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Azerbaijan
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Bahamas
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Bahrain
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Indonesia
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Italy
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Lesotho
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Libya
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Vatican City
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Vietnam
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Wallis & Futuna
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Yemen
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Zambia
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Zimbabwe
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Åland Islands
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Cell Phone
*
United States +1
United States
+1
United Kingdom
+44
Afghanistan
+93
Albania
+355
Algeria
+213
American Samoa
+1
Andorra
+376
Angola
+244
Anguilla
+1
Antigua & Barbuda
+1
Argentina
+54
Armenia
+374
Aruba
+297
Ascension Island
+247
Australia
+61
Austria
+43
Azerbaijan
+994
Bahamas
+1
Bahrain
+973
Bangladesh
+880
Barbados
+1
Belarus
+375
Belgium
+32
Belize
+501
Benin
+229
Bermuda
+1
Bhutan
+975
Bolivia
+591
Bosnia & Herzegovina
+387
Botswana
+267
Brazil
+55
British Indian Ocean Territory
+246
British Virgin Islands
+1
Brunei
+673
Bulgaria
+359
Burkina Faso
+226
Burundi
+257
Cambodia
+855
Cameroon
+237
Canada
+1
Cape Verde
+238
Caribbean Netherlands
+599
Cayman Islands
+1
Central African Republic
+236
Chad
+235
Chile
+56
China
+86
Christmas Island
+61
Cocos (Keeling) Islands
+61
Colombia
+57
Comoros
+269
Congo - Brazzaville
+242
Congo - Kinshasa
+243
Cook Islands
+682
Costa Rica
+506
Croatia
+385
Cuba
+53
Curaçao
+599
Cyprus
+357
Czechia
+420
Côte d’Ivoire
+225
Denmark
+45
Djibouti
+253
Dominica
+1
Dominican Republic
+1
Ecuador
+593
Egypt
+20
El Salvador
+503
Equatorial Guinea
+240
Eritrea
+291
Estonia
+372
Eswatini
+268
Ethiopia
+251
Falkland Islands
+500
Faroe Islands
+298
Fiji
+679
Finland
+358
France
+33
French Guiana
+594
French Polynesia
+689
Gabon
+241
Gambia
+220
Georgia
+995
Germany
+49
Ghana
+233
Gibraltar
+350
Greece
+30
Greenland
+299
Grenada
+1
Guadeloupe
+590
Guam
+1
Guatemala
+502
Guernsey
+44
Guinea
+224
Guinea-Bissau
+245
Guyana
+592
Haiti
+509
Honduras
+504
Hong Kong SAR China
+852
Hungary
+36
Iceland
+354
India
+91
Indonesia
+62
Iran
+98
Iraq
+964
Ireland
+353
Isle of Man
+44
Israel
+972
Italy
+39
Jamaica
+1
Japan
+81
Jersey
+44
Jordan
+962
Kazakhstan
+7
Kenya
+254
Kiribati
+686
Kosovo
+383
Kuwait
+965
Kyrgyzstan
+996
Laos
+856
Latvia
+371
Lebanon
+961
Lesotho
+266
Liberia
+231
Libya
+218
Liechtenstein
+423
Lithuania
+370
Luxembourg
+352
Macao SAR China
+853
Madagascar
+261
Malawi
+265
Malaysia
+60
Maldives
+960
Mali
+223
Malta
+356
Marshall Islands
+692
Martinique
+596
Mauritania
+222
Mauritius
+230
Mayotte
+262
Mexico
+52
Micronesia
+691
Moldova
+373
Monaco
+377
Mongolia
+976
Montenegro
+382
Montserrat
+1
Morocco
+212
Mozambique
+258
Myanmar (Burma)
+95
Namibia
+264
Nauru
+674
Nepal
+977
Netherlands
+31
New Caledonia
+687
New Zealand
+64
Nicaragua
+505
Niger
+227
Nigeria
+234
Niue
+683
Norfolk Island
+672
North Korea
+850
North Macedonia
+389
Northern Mariana Islands
+1
Norway
+47
Oman
+968
Pakistan
+92
Palau
+680
Palestinian Territories
+970
Panama
+507
Papua New Guinea
+675
Paraguay
+595
Peru
+51
Philippines
+63
Poland
+48
Portugal
+351
Puerto Rico
+1
Qatar
+974
Romania
+40
Russia
+7
Rwanda
+250
Réunion
+262
Samoa
+685
San Marino
+378
Saudi Arabia
+966
Senegal
+221
Serbia
+381
Seychelles
+248
Sierra Leone
+232
Singapore
+65
Sint Maarten
+1
Slovakia
+421
Slovenia
+386
Solomon Islands
+677
Somalia
+252
South Africa
+27
South Korea
+82
South Sudan
+211
Spain
+34
Sri Lanka
+94
St. Barthélemy
+590
St. Helena
+290
St. Kitts & Nevis
+1
St. Lucia
+1
St. Martin
+590
St. Pierre & Miquelon
+508
St. Vincent & Grenadines
+1
Sudan
+249
Suriname
+597
Svalbard & Jan Mayen
+47
Sweden
+46
Switzerland
+41
Syria
+963
São Tomé & Príncipe
+239
Taiwan
+886
Tajikistan
+992
Tanzania
+255
Thailand
+66
Timor-Leste
+670
Togo
+228
Tokelau
+690
Tonga
+676
Trinidad & Tobago
+1
Tunisia
+216
Turkey
+90
Turkmenistan
+993
Turks & Caicos Islands
+1
Tuvalu
+688
U.S. Virgin Islands
+1
Uganda
+256
Ukraine
+380
United Arab Emirates
+971
United Kingdom
+44
United States
+1
Uruguay
+598
Uzbekistan
+998
Vanuatu
+678
Vatican City
+39
Venezuela
+58
Vietnam
+84
Wallis & Futuna
+681
Western Sahara
+212
Yemen
+967
Zambia
+260
Zimbabwe
+263
Åland Islands
+358
Email
*
Email
Confirm Email
Spouse’s Name and birthday (if applicable):
How many children in your home? (And their ages)
Are there any other people residing in your home? Please list :
*
Street
*
City
*
State
*
0 of 2 max characters.
ZIP
*
0 of 5 max characters.
How long have you resided at this address (in years)?
*
Is this where the pet will live with you?
*
Yes
No
If no, list address where pet will reside:
Type of dwelling
*
House
Apartment
Condo
Mobile Home
Do you Rent or Own?
*
Own
Rent
Have you received permission from your landlord?
*
Yes
No
If renting, what is your Landlord’s name and phone number:
Place of employment, job title and location (if student or retired, etc. please state):
*
What type of outdoor exercise will the pet have access to
*
I. E. fenced in yard, dog park; walking on a leash; etc.
What do you think makes this particular pet(s) a good choice for you?
*
What will happen to the pet if you move?
*
Have you had experience with pets?
*
Yes
No
Please explain your past experience with pets:
How many hours are you away from home during the average work day?
*
Where will your pet(s) be kept during that time?
*
Where will your pet(s) be sleeping during the night?
*
What kind of other pets do you have in the home? Please list type, breed and gender:
*
Are they all current on their vaccinations?
*
Yes
No
Are they all spayed/neutered?
*
Yes
No
Your Veterinarian’s Name and Address:
*
Your Veterinarian’s telephone number:
Does anyone in the household have pet allergies?
*
Yes
No
If yes, please explain how you treat/will treat allergies:
Does anyone in the household have asthma?
*
Yes
No
Have you or anyone in your household ever been convicted of animal cruelty, neglect, or abandonment, or a violent felony?
*
Yes
No
Have you ever had to give up a pet?
*
Yes
No
If yes, please explain:
Are there any other comments you would like to make?
Would you consider being a foster home for some pet in the future?
*
Yes
No
How did you hear about Speedway Animal Rescue or what was the method you used to find this pet?
*
We value our volunteers. Speedway Animal Rescue is manned by all volunteers. Would you be interested in Volunteering?
*
Yes
No
If yes, in what capacity? Transporting of a pet, perform Home Visits, Fund Raising, Data Inputting, Events, helping with Chewy Pet Supplies days & Other?
Name:
*
Date
*
Please note that filling out this adoption application does NOT guarantee that the animal you are applying for will be adopted to you. This application simply helps us to determine if you and the animal for which you are applying are a good match. I certify that all information I have given in this application is true and correct to the best of my knowledge and belief. I give permission to agents of Speedway Animal Rescue to verify information as needed. I understand that any false statement will terminate potential adoption. I understand that Speedway Animal Rescue has the right to approve or deny this application in accordance with its policies. I understand that a home check may be mandatory prior to adopting a pet.
Email
Submit
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