Another Chance Pet Rescue - Dog Application

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Note: You may download the MS Word document (right-click, save as), fill it out and email it to us, or bring it to an Adoption Event at Petco in Irondequoit (Wednesdays 6pm-8pm and Saturdays 11am-3pm):

Dog Application Please answer every question (enter N/A if question does not apply to you)
Are you applying to:	Adopt Foster
Dog's Name/Breed:
Your Name:
Address:
City:
State:
ZIP:
Home Phone:
Work Phone:
Occupation:
Employer:
Email Address:
Driver's License Number:
How many adults in household?:
Number of children in household:
Children's Ages:
All adults in agreement about adopting?:	Yes No
Who will be responsible for the pet?:
If this dog will be a gift, who is it for?:
Is anyone in household allergic to pets?:	Yes No
Does anyone in your home smoke?:	Yes No
If so, smoke inside the house?:	Yes No N/A
Max # hours pet will be left alone daily:
Are you moving in the next 12 Months?:	Yes No
Do you own or rent your home?:	Own Rent
If renting, name and number of landlord:
Where will your dog be kept?:
If yard is fenced, what type of fence?:
What training/activities will you provide?
Current dog breed(s) gender(s) & age(s):
Why do you want another dog?:
If you have cats, list age of each:
Where did you get your pets?:
Are all pets spayed/neutered?:	Yes No N/A
Are all pet(s) vaccinations up to date?:	Yes No N/A
If not, why?:
Do they get along with other animals?:
Have you had other pets in last 5 years?:	Yes No
For how long/what happened to them?:
Your veterinarian(s) name and phone #:
Have you tried to adopt in last 12 mo?:	Yes No
Will you agree to a home visit by ACPR?:	Yes No
By submitting this application, I hereby certify that all answers I gave are true to the best of my knowledge. I understand that ACPR may accept or deny any request.

anotherchancepetrescue@netzero.net

Site by Mark Osterling