First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

Occupation*

Are you at least 18 years of age?*

How many adults in the home? Please list their names and relationship to you.*

How many children (under 18)? *

Please list ages of children:

Are you expecting a child or planning a family in the near future?
Choose all that apply: Yes No

Does anyone in your household smoke inside the home?*

If yes, how will keep the animal safe from second hand smoke?

Do you own or rent your home?

How long have you lived at this address?*

Type of Dwelling

If you rent please give name, address, phone number, and email address of landlord:

If you rent does it state in your lease that dogs/cats are allowed?

If you rent or own a condo/townhome please give name, address, phone number and email address of homeowners association president/representative:

If you rent or own a condo/townhome does your landlord/homeowner association allow dogs?

Are there any weight or breed restrictions?

If so, what are the restrictions?

Does your homeowners or renters insurance company/policy have a breed ban?

If so, which breeds are included?

How close is the nearest highway/busy street to your home?*

How many consecutive hours PER DAY are you away from home for work, school, etc.? *

Have you ever adopted an animal from Redemption Road Rescue before? *

Why are you looking for a new companion animal?

If you are interested in a particular animal, please specify who:
Choose an animal: Alf *FOSTER HOME NEEDED* Artie Bailey Beau *FOSTER HOME NEEDED* Birdie Bonnie & Clyde *FOSTER HOME NEEDED* Cheeto *Help! I need a foster home!* Cricket **Foster Home Needed** Emerson Forrest Gracie Huey & Louie Ivy Jan Kobe "Gentle Giant" Easygoing and sweet! Lulu *FOSTER HOME NEEDED* Martha Nacho *FOSTER HOME NEEDED* Rambler Reese & Rory Remi *FOSTER HOME NEEDED* Roxy & Penny *Bonded Seniors* Sadie *Wonderful Family Dog!* Smokey Tera *FOSTER HOME NEEDED* Tippy Vortex *FOSTER HOME NEEDED* Yeti

Why do you feel this animal would be a good addition to your family? What made you choose this animal?

What kind of research have you done on the breed of dog you are interested in adopting? How and why do you believe this dog will will fit into your lifestyle?*

What characteristics are you looking for in an animal? Any particular gender or age?*

Do you agree to return the animal to Redemption Road Rescue, should you no longer be able to keep the animal (meaning you will not re-home the animal yourself or bring to another shelter)?

Does anyone in your household have allergies?

If yes, what type of allergies?

Do you have a fenced yard?

If so, does the fencing completely enclose the yard?

Fence Height:

Fence Type:

If you do not have a fenced in yard, how do you plan to keep your new dog safe?

How will the dog get its daily exercise?*

Where will the dog sleep?*

Where will the dog be kept when no one is home?*

How will you plan on training the dog? Please elaborate:*

Do you plan to use a crate?

What will happen to the dog if you have to move out of current dwelling? *

Have you ever moved from one residence to another without taking your pet? Please explain the situation:*

What will you do if this dog grows to be larger than you expect? *

Are you aware of the animal leash and license laws in your city?

Animal limit? *

Please tell us about your current dog(s), if any. List the following information for each dog you currently own: Name, breed, sex, age, whether or not the dog is spayed/neutered, and whether the dog lives indoors or outdoors.*

Please tell us about your current cat(s), if any. List the following information for each cat you currently own: Name, breed, sex, age, whether or not the cat is spayed/neutered, and whether the cat lives indoors or outdoors.

Please list any pets you have previously owned, along with the following information: Breed/species, how long the pet was owned, was it kept indoors or outdoors, was it spayed/neutered, and where the pet is now (if deceased, please list cause of death).*

Have you ever had to give a pet up? If so, please tell us why?*

Under what conditions would you not keep your new pet?*

What is your definition of disciplining your dog?*

What is the name and location of the vet you are seeing/will be seeing?*

Will you be using a Heartworm Preventative?

Do you plan on using flea preventative regularly?

We love all the animals that enter Redemption Road Rescue and become attached to our rescued animals. Do you agree to allow follow-up contacts or scheduled visits to see how everything is going?

It is very common for animals to have accidents in their new home as they get acclimated to their new environment and schedule. Do you understand it may take your pet anywhere between 2 weeks to 6 months to adjust to its new surroundings and for its true personality to emerge?

Please list two NON-FAMILY personal references, their relationship to you, and their phone or email. Personal reference #1*

Relationship

Phone number and/or email:

How long have you know reference #1?

Personal reference #2*

Relationship:

Phone number and/or email:

How long have you know reference #2?

E-Signature: I, the undersigned, attest that, to the best of my knowledge, the above information is accurate and complete at the time of signing. I understand that falsely provided information can mean that my application will be terminated.*