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Adoption Application
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Adoption Application
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Pet name
*
Birth Date of Applicant
*
Home Phone
*
Cell Phone
*
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
*
ZIP
*
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.
Name
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