First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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County

Country

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Applicant Full Name:

Applicant Age*

List all names & ages of all residing in the household.

Animal Name:*
Choose an animal: Benji Charity Chester Sadie Skylar Tabitha Zack Zane

Breed:

Description (color, special markings, etc.)

Male:

Female:

Microchip Registration #

What characteristics are you hoping to have in your pet?
Choose one: Male Female Baby Young Adult Declawed Companion Protective Companion for Another Pet

Why are you interested in adopting a pet at this time*

Have you applied with any other rescue*
Choose one: Yes No

How did you hear about us*

How much time will the animal spend alone during the day*

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal be kept when you are home*

Where will the animal be kept when you are not home*

Where will the animal sleep*

How many times will you walk your pet per day

How do you plan to housetrain your pet

Describe how you will train the pet*

What would you do if your dog develops problem such as digging:

1

Barking

Separation Anxiety

Chewing

Aggression

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

What type of fence
Choose one: Privacy Chain Link Invisible

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you have a Homeowners Association or Condo Owners Association?

If you checked yes to Homeowners Association or Condo Association, please provide name and contact ph #.

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

Any Pet Restrictions? (Check All That Apply)

Who in the household will care for the pet*

Have you had pets in the past or do you currently have pets?

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Please tell us about them (if applicable)

Are your pets spayed or neutered?

Current on Heartworm?

Up to date on vaccines?

Veterinarian’s Name & Phone Number:

Have you ever given up a pet? If yes, please explain*

How long have you been employed?

Employer's Name

Employer's Phone Number

List at least two references (who are not family members) and Ph #"s

In case of Emergency who would care for the pet

I certify that the information entered on this applicant is true. Enter your name and date*

Adoption Contract: You will be asked to sign this agreement at the time your application has been approved and you decide to adopt an Everglades Angels dog.

PLEASE READ CAREFULLY Adopting a pet is a serious and long term commitment. A pet you adopt today will likely be a part of your family for the next 10 to 15 years! Each pet has its own personality and preferences that you can help shape through love and conscientious training. A dog makes considerable demands on your time and resources. Dog parents need to spend time walking, grooming, training, and playing with their dogs every day. Some dogs may require professional grooming or training. Dogs require special food and regular veterinary care. This includes annual vaccination and MONTHLY PREVENTIVE MEDICATIONS FOR HEARTWORM AND FLEAS AND TICKS! Even in the case of healthy animals, these expenses can exceed $1,500 a year. *If you are adopting a PUPPY, please be aware that they may not be finished with the required puppy shots. It is the Adopters Responsibility to ensure that your Puppy receives the required additional vaccinations. *EVERGLADES ANGELS DOG RESCUE™  has the right to request proof of required additional puppy vaccinations. 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) Are you prepared to accept the financial and personal responsibility for a pet? Yes No A representative from EVERGLADES ANGELS DOG RESCUE ™ may follow up with you and your pet by visiting you in your home or by talking with you over the phone. We would visit your residence by appointment only. Are you willing to allow a representative to follow up to see how the dog is doing in his/her new home? Yes No I agree that if at any point I cannot keep the animal, I will return him/her to EVERGLADES ANGELS DOG RESCUE ™._______ (initial) I understand that EVERGLADES ANGELS DOG RESCUE ™ has the right to deny any application. I give permission for a representative of EVERGLADES ANGELS DOG RESCUE ™ to call the references and veterinary practices I have listed.______ (initial) This is a legally binding contract. I agree that all statements I have made on this Application are true. If it is found that any statements I have made on this Application are not true, the Adopted animal will be confiscated and brought back into the Loving Care of EVERGLADES ANGELS DOG RESCUE ™. All Household Residents must be in Total Agreement of the Adoption. All persons residing in the residence above the age of 18 must sign and date.

Applicant Signature: ___________________________________________Date:_________

Co-Applicant Signature: __________________________________________ Date: _________

This Application has been approved by EVERGLADES ANGELS DOG RESCUE ™

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