By filling out this form and submitting to All Pet Rescue, I hereby confirm I have read and agree to the "Pet Placement Agreement" in its entirety.  I also under stand that prior to any animal being released to me I will sign the Pet Placement Agreement , Pet Placement Application and any other necessary forms as set forth by All Pet Rescue.

Adopting a pet is a lifelong commitment that should be taken seriously. We strive to match owner lifestyles with pet personality, special needs and breed type so that your pet will benefit from a healthy, fulfilling relationship. * Applicant must be 21 years or older.

To help us identify the pet you are interested in please fill out the following:
Pet's Name: Type of Pet Select Cat Dog Ferret Bird Other Pet

Name:
Address:
City, State, ZIP:
Home Telephone: Work Telephone:
Cell Phone:
Email Address (So we can reply to you):
Driver License Number: State:

Employer:
Address:
City, State, ZIP:
Telephone Number:

How many adults in home?
Number of Children Living at home? Ages:
Is any family member afraid of pets? Yes No
Is any family member allergic to pets? Yes No

Where will you keep your pet? In house Outside in fenced area     Size of fenced area?

Do you live near a highway or heavy traffic? Yes No

Why do you want this pet? For self Gift Companion for Family Companion for other pet Guard Dog

Is everyone in you home in favor of adopting a pet? Yes No

Who will care for pet while you are on vacation?

What if you Move?

How much time can you spend with your pet daily?

Have any of your pets died in the last year? Yes No   If yes give reason

Do you have time & patience to exercise, housebreak & train your pet? Yes No

How long have you lived at this address:
Is this address a: House Condo Apartment Mobile Home
Do you own or rent this property? Own Rent

If you rent: 
Are pets allowed? Yes No Not Sure   Is a pet deposit required? Yes No
Landlords Name:
Landlords Address:
City, State, ZIP:
Telephone Number:

Current Veterinarian:
Name:
Address:
City, State, ZIP:
Telephone Number:

Have you ever adopted a pet & returned it? Yes No  Reason:

Current Pets in the home:
Type: Cats: Dogs: Birds: Ferrets:      
Do you agree to spay / neuter this pet if not done already?: Yes No
Are your other pets current on all vaccinations?: Yes No
Are your other pets spayed / neutered?: Yes No
Are your pets on heartworm preventative?: Yes No      What Type?:

I further understand that any sum of money I have given to ALL PET RESCUE is a donation toward its efforts in caring
for this and other animals and there are NO REFUNDS.

All Pet Rescue. is adopting out to you a pet that is believed to be in good health. Any known physical or behavioral problems will be disclosed to you in writing. All Pet Rescue, . assumes no responsibility for properties of yours or others destroyed by a Homeward Bound-adopted animal. Neither does All Pet Rescue, . assume responsibility for bites or injuries inflicted by said animal. You, as the adopter, have a right to return or exchange the adopted animal within 30 days of the adoption date if the animal becomes ill or is unsatisfactory as a pet. No refund will be given.

All Pet Rescue, reserves the right to inspect and assess the quality of care to the adopted animal at any time with proper notice given to the adopter. All Pet Rescue, reserves the right to remove any adopted pet from an environment deemed not to be in its best interest as agreed to in this agreement.

I have read the terms and conditions listed on this form and the "Pet Placement Agreement". My signature below indicates that I will abide by all of those terms and conditions. I agree to provide the Required Medical Care.

Adopting Party Name: Date:
Signature: