RescueConnect NC

Adoption Application

By submitting this application, I authorize any veterinarian or veterinary hospital/professional/kennel to furnish or discuss with any representative of RescueConnect all records in their possession regarding the care of the applicants past or present animals. This authorization shall remain valid for one year after the date it is submitted. Upon presentation of this release of information or a photocopy of same, you are directed to permit the personal review or discuss with a representative of RescueConnect the veterinary/kennel records.

Full Name

Number of Adults in Home

Number of Children in Home

Name of Adults in Home

Address

Home Phone

Cell Phone

Employer

Occupation

Housing Situation

Rent/Own

Landlord's Name

Landlord's Contact Number

Do you have a fenced yard?

Cat or Dog?

Animal Name (optional)

Where will the animal be exercised and allowed to use the bathroom?

Are you a previous or current pet owner?

List the type, breed, gender, age, spayed/neutered and length of ownership of current pets.

How do other family/household members feel about adopting an animal?

How often will the animal be left alone during the daytime?

How often will the animal be left alone during the nighttime?

Where the animal will be kept during the day?

Where the animal sleep at night?

Where will the animal be kept and who will take care of the animal if you have to travel?

Anyone in home allergic to cats or dogs?

Are you willing to house train the animal?

Are you willing to obedience train the animal?

Are you willing to have a home visit by RescueConnect?

Please explain why you are not willing to have a home visit prior to adoption.

Name of Vet

Vet Phone Number

Vet Address

RescueConnect may wish to complete a home visit 3-6 months after the adoption.

I have read and accept the release of liability and waiver