First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Work Phone x
Cell Phone*
Alt Email
Text/Pager Email
Which animal are you applying to adopt?* Choose an animal: Agatha Asher Baxter Carmel kitty Doll Eyebrow Gary Gemma Star Hazel Mae Hubbell Josie Kleo Lava Lilly- Courtesy post Love-ly Luckey Luna Lovegood Marisol Meko Mellow Mousse Papa Roseanna Sawyer Scoutt Taffieta Tinkie Toffee Winny Wrenlee Zahara
Name of Spouse or Significant Other:
List any additional members of your household.*
Ages of person(s) in household members*
Are you prepared to take care of this animal for 15-20 years?
Are you prepared to cover vet expenses that your pet may incur throughout its life? If so, is there a limit per incident?*
Why are you looking to adopt this animal?
What kind of home do you occupy?* Choose one: House Apartment Condo Other
Do you have plans to move in the near future?
If you do have plans on moving, where will you be going?
If you at any time move, change living arrangements, or travel, what would you do with your animal companion?*
Does the place you are currently living at allow pets?
If you rent your home, condo, or apartment, please fill in the landlord's information below.
Have any of your current dogs had any of the following problems? (check all that apply)
Is there a particular behavior that would be unacceptable to you?*
Under what circumstances would you no longer be able to keep your animal? Check as many as apply.
Where will your new pet sleep at night?
Do you have any of the following places as part of your home? Please check those that apply.
How many hours will your companion be left alone per day?*
If any of your previous pets are no longer with you, please explain what happened to them. If this question doesn't apply to you, please put 'n/a' in the box.*
In which parts of your home will the animal be allowed?*
If you were unable to keep the animal, what would you do with him or her?
Are you willing to have a representative of the rescue visit your home?
If you currently have a veterinarian, please put their information in the box below. Please note that we may call and verify you are actually employing their services.*
Do you have other pets, or do you currently own other pets? Please list them here and indicate if they are dogs, cats, or another type of animal. *
Where did you find out about this animal?
Would you like to add anything to your application, or would you like us to take any additional information into consideration?*
THIS QUESTIONNAIRE BECOMES PART OF OUR CONTRACT. I certify that all the above information is true and accurate. I understand that if I adopt a pet from DREAM Animal Rescue and its officers, this document will become part of the adoption record.* Choose one: Yes No
