If You Are looking To Adopt Or Foster An Animal Please Feel Free To Copy And Email The Application Back To Me Or Feel Free To Mail It To Me

Elizabeth Avery
Avery Reptile And Small Animal Rescue / Shelter For All Animals

This Is are form we us when people are signing over there pets to us that they can't keep
Avery Reptile & Small Animal & Removel Services
I _______________________ hear by release care of _____________________ for _________________________ reasons to _________________________ at the Avery Reptile & Small Animal & Removel Services as forth with that I can no longer care for them.
I ___________________________ hear by release care of ____________________ to be temporary housed with _______________________ from the Avery Reptile & Small Animal & Removel Services for this ____________ of days determined and agreed upon by both party's. Temporary housing extending 30 to 60 days contact must be keep between both party's under temporary housing If contact Is not keep during the 60 days housing will be come permanent do to thoughts thee animal has been abandoned.
I _______________________am adopting ___________________from the Avery Reptile And Small Animal Rescue & Removel Services on this ____ day of _______________ month If any problems after adoption I will contact _______________________ at the Avery
Reptile And Small Animal Rescue & Removel Services for any help I may need.
If you have any questions or comments at any time please feel free to contact us at or 401 - 826 - 0916 Averyreptilerescue@yahoo.com Elizabeth & George Avery Reptile And Small Animal Rescues And Removel Services _______________________________________________________________

COMPANION ANIMAL ADOPTION AGREEMENT

ADOPTER'S INFORMATION:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

References Checked: Y/N

Homecheck Completed: Y/N ________ (initial)

INFORMATION ABOUT ADOPTED ANIMAL:

Cat/Dog/Other

If other, specify:

M/F

Date of Birth:

Color:

Other description:

ADOPTER'S AGREEMENT

I agree that the animal is being adopted for myself and will not be sold, adopted, or given to another party. _________ (initial)

I agree that the animal will not be allowed outdoors without proper supervision. When taking my dog outdoors, they will be on a secure harness and wear proper ID. _________ (initial)

(If adopting a cat) I agree that I will not declaw the cat or allow the cat outdoors. _________ (initial)

(If adopting a dog) I agree that this dog is to be a companion animal, not a guard dog. The dog will live inside my home, not outdoors. _________ (initial)

I agree to care for the animal in a humane manner and be a responsible animal guardian. This includes supplying adequate food, water, shelter, attention, and medical care. _________ (initial)

I agree that if at any point I can not keep the animal, I will return him/her to the original rescue without requesting a fee. _________ (initial)

I understand and agree that the current rescue makes no guarantees about the animal's temperament and is not responsible for future damages or injuries caused by the animal. _________ (initial)

I give the current rescue permission to call my home at any reasonable time to assure that the animal is being properly treated and cared for. _________ (initial)

I agree to keep the rescue informed of my current home address and phone number. _________ (initial)

I agree that all statements I have made on this form are true. If it is found that any statements I have made on this form are not true the adopted animal can be confiscated.

Name:

Address:

City:___________State:____________

Zip Code:

Phone Number:

Driver's License Number:____________

Social Security Number:

Adopter's Signature:
Date:

Current Guardian's Signature:

Date: ________________________________________________________________
Do Not Fill Out This Part Of The Form office Use Only
Home Check Evaluation Form

This is an example of a form which could be used when doing a home check.

While doing a home check, get as much information as possible and do not be afraid to ask questions.

For safety reasons, always bring another person with you.

A home check should be performed after an initial adoption application has been approved.

Applicant's

Name:

Phone:

Email:

Address:

Type of Dwelling: (Circle One) Single family home____? Town house_____? Condo____? Mobile Home____? Apartment____? Multi family home_____? Military____?

Size of Home: [estimate square footage if possible] Setting [circle all that apply]: Rural____? Semi rural____? Suburban ____? Semi urban ____? Urban ____? Wooded ____? Open acreage ____? Waterfront _____? Highway frontage ____? Neighborhood street frontage ____? City environment ____? Property bordering on park/field ____?

Condition of Home [circle all that apply]: Immaculate____? Well-kept ____? Lived in but clean____? Exterior untidy _____? Interior untidy _____? Exterior unkept/poorly maintained ____? Interior trashed/dirty _____?

Describe the home interior: [Include type of furnishings, flooring, and general appearance. For example, "antiques with museum atmosphere", "shabby furniture", "brand new furniture and/or carpet", "hardwood/ vinyl flooring with some carpet/rugs", etc.]

Accommodations: [Describe what accommodations the home has for a new companion animal and where this animal will be left when the guardians are not at home. For example, "access to entire home", "crate in kitchen/laundry room", "baby gate across kitchen", "basement", "garage", "outdoor run", etc.

Children: [Give ages of children, if any, and pay special attention to the behavior of the children, the parents' responses and method of discipline, and the children's interactions with other companion animals.
Note whether parents always supervise young children with other animals and if the parents seem to expect the child/children to be "responsible" for the care of the other animals.]

Family Environment: [Describe the behavior of the adults among themselves, and to any other companion animals or children.
Are they respectful, patient, hectic, noisy, loud, quiet, commanding, etc.?]

Lifestyle Compromises: [Has the applicant thought through life-style compromises that will be required when a new animal is adopted? Give details.]

Other Companion Animals:
[Describe number, type, age, and gender of the other companion animals and give complete description of their apparent health and well being.
Things to note would be skin or flea problems, condition of nails, overweight or underweight, type of collar, i.d tags, etc.]

Applicant Interaction With Other Companion Animals: Describe the relationship all family members seem to have with other companion animals.

What role will the animal play in applicant's life?______ Are the other companion animals treated like family members?______ How do the other animals behave?__________ If applicant is looking for an additional companion animal, why does applicant want another?___________ Has applicant ever lived with more than one companion animal at the same time?_______________ Is applicant prepared for the increased work, expense [including vet cost], and commotion?________________ How committed is applicant?________________ How does potential applicant respond to good and bad behaviors?_________ Does applicant demand perfection or have unreasonable expectation regarding behaviors?________________ How do the animals react to the applicant? Do the present animals seem happy, content?_________________

Important
Explain that re-homing a dog/cat is stressful for the animal.

Rescued dogs may have training accidents, even if they are housebroken, while they are in their present home or foster care, for the first few weeks.

Rescued cats may have accidents outside of the litter box and sometimes suffer from vomiting/diarrhea due to stress.

Ask the applicant what they would do or how they would react to the new dog/cat having an accident.

What was their reply?

Additional Information:

Please describe any additional information about the home environment that you feel is pertinent.

Is there anything in general or specifically that would cause you to feel uncomfortable about placing an animal in this home? If so, what?

"Gut feelings" are considered important.
Would you feel comfortable leaving your own animal with the applicant?

Explain.
Cats:For cats, please look into things such as:

Are there a sufficient amount of litter boxes for all of the cats present?_______________ Are the boxes clean?__________ Is applicant prepared for the extra work?_____________ Will the cat be kept indoors all the time?___________ Do all windows have secure screens?______________ Are there toys and scratching posts around for cats that already live there?________________ Is applicant prepared for the possible destructive behavior to the furniture such as clawing and scratching things, climbing curtains, getting into plants, and mischievous things cats do?_______

Dogs:For dogs, please look into things such as:

Include complete description of any pen or kennel [chain link run, dirt run with chicken wire, etc].

Will the dog ever be left chained outside or left unattended in a fenced-in yard?__________ Describe the fencing, if any, and consider security of fence.

Do other dogs in the home obey happily?____________ Does applicant believe that the new dog will "train" old dog or vice versa?______________ Are the other dogs out of control and undisciplined?_____________ Are there toys around for the dogs who already live there?___________ Does applicant appear to know some basic training techniques?__________ Is applicant prepared for the extra time and costs that might be involved with training?____________

Conclusion:

Approve Applicant

Do not approve applicant

Approve after additional counseling of applicants and/or
Approve after modifications to the home environment

Please describe:

Additional comments:

Home Evaluator's Signature:

Date:

Contact information: ________________________________________________________________

COMPANION ANIMAL ADOPTION APPLICATION

Date:

APPLYING FOR:

Name of Animal:
Species:
Description:
Age:
Special Needs:

APPLICANT'S INFORMATION:

Full Name:

Address:

City:

State:

Phone Number:

Age:

HOUSEHOLD INFORMATION:

Where Do You Live? (Please circle one) House______? Condo/Apt. ______? Mobile Home_______? Student Housing _______? Military Housing _______?

Neighborhood (Please circle one): Urban / Suburban / Rural

How long at your present address?

Do You Own Your Own Home? Y/N (If yes, please provide proof of ownership.)

Do you rent? Y/N
If yes,
Landlord's Name:
Landlord's Phone Number:

Are you planning to move within the next year? Y/N If yes, what are your plans for your companion animal when you move?

If you decide to move in the future, what will you do with your companion animal?

What provisions have you made for your companion animal in the event of your illness or death?

How many adults in your home?

Are there children in your home? Y/N If yes, how many and what are their ages?

Are all members of your household aware of your plans to adopt an animal? Y/N

Are any members of your household allergic to animals? Y/N
Where will your companion animal sleep?
How many hours will your companion animal be alone?
Who will be responsible for the animal?
Does anyone in your household smoke? Y/N If yes, where?
Do you have any health conditions which could restrict your ability to care for an animal? Y/N If yes, please describe:
VACATION:
How often do you go on vacation?
What will you with your companion animal when you go on vacation?
EMPLOYMENT:
Employer:
Occupation:
How long at your present job?
Can you be contacted at your job? Y/N
If yes, work phone #:
OTHER ANIMALS:
Do you have cats? Y/N
If yes,
How many?
Do the cats live strictly indoors? Y/N
Are the cats de clawed? Y/N
Do you have dogs? Y/N
If yes,
How many?
Do dogs live indoors? Y/N
Other animals? Y/N
If yes, How many?
Describe living conditions of other animals:
Are all animals in your household spayed/neutered? Y/N
Name of Veterinarian:
Address:
Phone Number:
If no companion animals at this time, have you had any in the past 8 years? Y/N
If yes, what happened to them?
REFERENCES:Please list 3 people other than family who you have known for at least 5 years.
Name:
Phone Number:
Name:
Phone Number:
Name:
Phone Number:
QUESTIONS: (Use back of application to answer)
Why do you want to adopt an animal?
What type of personality are you looking for?
(If applicable) Have you ever had a special needs animal before? Y/N
If yes, describe:
If necessary, how will you discipline the animal?
I hereby certify that all information supplied by me on this application is true.
Signature:
Date:
********FOR OFFICE USE ONLY********
Reviewed by:
Date:
Driver’s license or other formal ID Verified: Y/N
Housing verified: Y/N
Date:
Comments:
Landlord Approval: Y/N
Date:
Comments:
Veterinary Reference Checked: Y/N
Date:
Comments:
***Final Approval***
YES / PENDING / DENIED
Date:
Animal Description:
Sex: M/F
Age:
Animal's new name: