First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Cell Phone

Birthdate*

Preferred Phone Number*

What is your occupation?*

Why are you looking to adopt a senior animal?*

Which animal are you hoping to adopt?*
Choose an animal: Al Chuy Henry (Bonded with Penny) Lily Marble Penny (bonded with Henry) Reba

What appealed to you about the animal(s) you are interested in?*

Do you rent or own your home?

If you rent, have you obtained permission from your landlord to have an animal?

If you rent, please provide contact information for your landlord/rental company (name, phone number and email address). Please note we can't move your application along without this.*

What type of home do you live in?

Are you aware of your city’s pet ordinance?

Do you smoke inside your home?

Are there children in your family? If so, please list their ages.*

List the full name of any other adults over the age of 18 living in your home. If none, put n/a.*

How many hours a day do you work?*

Is everyone in your home on board about adding an animal?*

Does anyone in the household have allergies to pets or pet dander, etc.?*

Do you have any other pets? If so, please list names, breed, age and if they are spayed/neutered.*

If you currently have pets, are they all up-to-date on vaccinations? If no, please explain.*

May we contact your vet to confirm vetting status? If so, please provide the vet clinic's name, city, phone number and what name the account is listed under. *

If you do not have a vet, please list the name and location of the vet clinic you plan to use.

How would you react if your animal destroyed a household object or soiled in the house?*

Have you owned any pets in the past 5 years that are no longer in your possession? If so, please explain what type of pet, how it was obtained, how long you had the pet, and why they are no longer with your family. *

Under what circumstances (besides your death) would you give up a pet?*

Are you willing to let a representative of Grey Face Rescue visit your home by appointment?*

I understand and agree that submitting this application does not automatically guarantee me approval to adopt an animal from Grey Face Rescue and that there are certain qualifications I must meet, including the acceptance of a successful home visit and signed contract, before I may adopt an animal. By submitting this form, I attest that the information I have provided is true and accurate.