alcovypet.com - Adoption Application

Name:
Name of animal you are interested in adopting:
Email Address:
Home Phone Number:
Cell Phone Number:
Home Address:
City:
State:
Zip Code
Do you rent, lease or own the property where you live?	Rent Lease Own
Do you now live in a:	House Mobile Home Apartment Condo
How long have you lived at this address?
If leasing or renting in a complex/property include name, address and phone number of leasing office or owner:
If leasing or renting is there a required pet deposit?	Yes No N/A
If leasing or renting has the pet deposit been paid?	Yes No N/A Will pay if approved for adoption.
If leasing or renting is there a weight limit for a pet?	Yes No N/A
How old are you?
Your Employer's Name & Address:
Work Phone Number (For Verification Purposes Only)
Who do you currently live with:	Spouse or Partner Family Parents Roommate(s) Alone
How many people live in your residence?
Are all household members aware that you are interested in adopting a pet?	Yes No N/A
Are there any children living in the home or that visit frequently?	Yes No
If there are children what are their ages?
Does anyone in the home have allergies? If so how will you address this?
Type of pet you are interested in? Breed, Coat type/length, Size, Age, and Sex:
Why are you interested in adopting?	Companion for self Companion for other pet Family pet Gift
If you are interested in adopting a dog, what will the dog be?	Family Indoor Dog Yard Dog Guard Dog Hunting Dog None of these
Is being housebroken a requirement?	Yes No Willing To Work With Pet
Please list any current pets. Name? Breed? Sex? Altered?
List all previous pets, how long they lived and their cause of death or where they are now?
Have you ever had a dog die of the following: distemper, parvo, heart worms or unknown causes?	Yes No N/A
Are all current pets up to date on vaccinations?	Yes No Unsure N/A
Do you use monthly heartworm prevention for your pets? If so what brand?
Do you use flee control on your pets? If so what kind or brand?
Are all current cats/dogs spayed or neutered?	Yes No Unsure N/A
If all current cats/dogs are not altered, please explain why.
Do you have a yard?	Yes No
Is your yard fenced?	Yes No N/A
What type of fencing is it?	Chain Link Welded Wire Wood Privacy Wood Picket Split Rail with Wire Undergound Radio Other
Where will your new pet live?	Indoors - Free To Roam Indoors - In a Crate Outdoors - Free To Roam Outdoors - Kennel Outdoors - Pen Outdoors - Tied Out
What type of food do you plan to feed your new pet?
How will you excersise your new pet?	Run In Fenced Yard Run In Unfenced Yard Dog Park Walks Cable Run or Tie Out N/A
List your current veterinarian's name or the clinic name:
Current vet's street address:
Current vet's location City, State and Zip Code:
Current vet's telephone number including area code:
List all previous veterinarian's names and phone numbers:
Would you object to an authorized Alcovy Pet Rescue, Inc. representative inspecting the premises where the animal will be kept both before and after adoption?	Yes No Unsure
Please list a personal reference that we may contact:
Have you ever surrendered an animal to a shelter or rescue? If so, why?
Do you have any additional comments regarding your application?
Alcovy Pet Rescue, Inc. is an independent, non-profit organization. We will in no way be held responsible for any adult, minor child, and/or their property while interacting with our animals during the application process. Alcovy pet Rescue, Inc. reserves the right to refuse any adoption for any reason. This application is the property of Alcovy Pet Rescue, Inc. By initialing this form, you are agreeing to the above statement and releasing Alcovy Pet Rescue, Inc.

Your vet reference information must include complete name of clinic, complete address, and complete phone number. If this is left blank, we will not contact you.

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