First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone*

Cell Phone

Middle name or initial*

Birthdate*

Preferred Phone Number*

What is your occupation?*

Have you ever used any other names (i.e. maiden, religious, professional, alias, etc.)? If so, please list them. If not, enter n/a. (By submitting this application you agree to a basic criminal history check and calls to your specified references.)*

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?*

Are you currently fostering the animal you would like to adopt?

Have you adopted or fostered with any other rescues in the past? If so, which one(s)?*

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 have any plans to move in the near future?*

Does your home have stairs? If so, please describe how many stairs the animal would have to go up/down during a normal day (steps to the outside included).*

Do you smoke inside your home?

Is your yard fenced?

If no fence, please specify how you will contain your pet outside (on a leash, tieout, etc.).*

Will your pet be left outside unattended? Please answer yes, no, or sometimes. If sometimes, please explain.*

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

List any other adults over age 18 living in your home or who visit regularly: Include name, age, occupation, relationship to you and whether the person will share in the responsibility for caring for the dog.*

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

How would you describe your lifestyle?*

What activities would you like the animal to participate in regularly with you?*

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.

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. *

Have you been convicted of any felonies in the past five years? *

If you answered yes to being convicted, what was the conviction for?

Where will the animal sleep at night?*

How many hours on average will your pet be left alone each day?*

Where will the animal be when everyone leaves the house?*

If you go on vacation, what do you plan to do with your pet?*

How often do you plan on walking your pet?

What are you looking for in a pet? (Check all that apply.)

Which characteristics would you not tolerate in a pet?

If your pet displayed one of these traits, what would you do?

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

How much grooming do you expect to do?

If you are applying for a pitbull or bully breed mix, please describe your experience with the breed(s).

Do you have homeowners insurance or renter's liability? (Please answer yes or no.) If yes, what company is the policy through?*

Animals are as individual as people. Are you willing to spend the time and effort to help this pet adjust to your home and lifestyle?*

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

Is there any other information you would like to provide us with as we consider your application?*

List at least ONE reference who can attest for your home life and your ability to care for a pet. Include their full name, phone number AND email. (These cannot be individuals who live in your home and at least one must have been to your home within the last 30 days. No more than one reference can be a relative.) We will attempt to reach your reference via email. They MUST respond in order for your application to move forward.*

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

How did you hear about Grey Face Rescue?*

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.