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All 4 One Adoption Application

Adoption Fees are as follows:

Poms/Pom Mixes $175-300

Other mixed breeds $150

All cats (unless purebreed) $75

All 4 One reserves the right to change adoption fees and these fees are NON-Refundable. Please note if this is a pre adoption there will be $100 refundable deposit when you bring the animal to its scheduled spay/neuter date.

Name_________________________________________ Home Phone____________________________

Address_______________________________________ Work Phone____________________________

City_____________ State ________ Zip _____________ Cell Phone____________________________

E-Mail Address_____________________________________________________________________________

I am at least 21 years of age? Yes____ No____

Occupation:________________________________________________________________________________

Employer _________________________________________________________________________________

Employer Address/Phone Number: __________________________________________________________________________________________

Local Personal References: (if possible please list one relative not living with you)

Name_________________________________

Phone__________________________________ Relationship_____________________________________

Name_________________________________

Phone__________________________________ Relationship_____________________________________

How did you hear about All 4 One Rescue? ______________________________________________________

Name of dog/cat you want to adopt ________________________ or __________________________________

To ensure that this adoption is in the best interest of both you and the dog you selected, we ask that you answer the following questions:

1) Please tell us what you would consider to be the perfect pet. What personality are you looking for?__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2) What kind of pet are you looking for?

Companion ___ Family pet ___ Childs pet ___ Friend for other pet ___ Gift___ Mouser___

3) Do you live in (select one): House___ Apartment___ Condo/Townhome___ Trailer___ Other___

4) Do you: Own____ Rent/Lease____ Name of Complex & Office Phone #_____________________________

5) Are you planning to move in the next six months? Yes_____ No _____

6) What will happen to this dog/cat if you move unexpectedly? __________________________________________________________________________________________

7) What will happen to this dog/cat when you go on vacation or in case of an emergency? __________________________________________________________________________________________

8) How many hours during the average day will your dog/cat be without a human?_______________________

9) Do you want this dog/cat to be (select one): Inside only____ Outside only____ Both____

10) Where will this dog/cat be kept during the day? ________________________________________________

Night? ________________________________ When you’re not home? _______________________________

11) Does your home have a dog door? Yes____ No_____

12a.) Do you have a fenced-in back yard? Yes ____ No _____

12b.) What kind of fencing do you have?___________________________________

*If your yard is fenced be sure to check for gaps and weaknesses in the fencing before bringing your dog home.

*If you are adopting a large dog consider if your fence is tall enough (6 ft).

13) Does your gate have a lock? Yes___ No____ If not could one be put on? ________

(Gates should always be locked so the dog cannot be let loose by neighborhood kids or utility service people.)

14) If there is no fenced yard how will you exercise the dog? How will the cat get exercise? __________________________________________________________________________________________

15) If the yard is not fenced who will walk the dog and how often will you take the dog out?________________

__________________________________________________________________________________________

16) What type of vehicle do you own? ________________ If you have a truck how will your dog/cat be transported? _______________________________________________________________________________

17) Please tell us why you would like to adopt a dog/cat? __________________________________________________________________________________________

__________________________________________________________________________________________

18) I am adopting this dog/cat for (check all that apply): myself___ spouse___ children___ gift____ other__ (please explain) ___________________________________________________________________________

19) Please list below all the people your dog/cat will be living with (including yourself):

Name Age Relationship to prospective adopter

__________________________________________________________________________APPLICANT

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

________________________________________________________________________________________

20) Did your entire family agree on the adoption of this one dog/cat? Yes ____ No _____

21) Will the whole family share in the care of this dog/cat? Yes _____ No _____

22) Is there any member of your household who is allergic to dogs/cat? Yes _____ No _____

23) Are there any children that visit your home frequently? Yes _____ No _____

If Yes, ages: _______________________________________________________________________________

24) Are there any regular visitors to your home, human or animal, with which your new dog/cat must get along?

Yes___ No___ If Yes, Describe:_______________________________________________________________

25) Do you have any other pets living with you now? Yes___ No___ If Yes, please list below:

Type (dog, cat, etc.) Breed Age Neutered/ Spayed? Owned for how long?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

26) Have you had pets in the past? Yes____ No_____ If Yes, please list below:

Type (dog, cat, etc.) Breed Neutered/Spayed Owned for how long? Where is the pet now?

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

27) Do you have a regular veterinarian? Yes _____ No ______

Clinic name, address, and phone number ________________________________________________________

28) May we have your permission to request information from your veterinarian? Yes _____ No _____

29) How often do you feel a dog/cat should see a veterinarian? _______________________________________

30) How do you feel about: Spaying/Neutering___________________________________________________ Regular vaccinations _________________________________ Outdoor cats/dogs ________________________ Euthanasia _________________________________________ Declawing(cat only) ______________________

31) What do you know about heartworms? _______________________________________________________

32) What will you feed your new dog/cat? _______________________________________________________

33) What kind of behavior do you find unacceptable? ______________________________________________

__________________________________________________________________________________________

34) If the dog/cat has problems with behavior what will you do about it? _______________________________

__________________________________________________________________________________________

35) What behaviors are you not willing to live with? __________________________________________________________________________________________

36) Who will clean the litter boxes daily? (Cat Adoption Only) _______________________________________

37) If the dog/cat needs daily medications are you willing to follow through with giving them?______________

38) Select all of the following that may cause you to give up an animal:

Birth of a child___ New roommate___ Marriage___ Divorce___ Biting___ Spraying___ Needs regular medication___ Allergies___ Other ___ None___

39) Have you ever had to return a pet to a breeder or take one to the pound, shelter or rescue? __________________________________________________________________________________________

*and if so why? ____________________________________________________________________________

40.) Are you against All 4 One Rescue to do a home visit prior to adoption and/or check on and/or visit the animal at your home? Yes____ No_____

*If at any time you are unable to care for this pet for any reason, you MUST return the animal back to All 4 One Rescue. Do you understand that you may NOT rehome this animal to another individual, shelter, rescue, etc? Yes____ No____

I certify that the above information is true and understand that false information may result in nullifying this adoption.

Applicant’s Signature ______________________________________________ Date_____________

WE RESERVE THE RIGHT TO REFUSE AN ADOPTION!

Thank you for completing the Dog/Cat Adoption Application. Please return it to an adoption counselor so that we may review it with you. The entire adoption procedure could take up to a week.

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