Date *
Pet(s) Interested in: *
Your Name *
Physical Street Address *
Mailing Address (or SAME-as Above) *
City *
State *
Country *
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahama
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Iislands
Costa Rica
Cote D'ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Islamic Republic of Iran
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova, Republic of
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Lucia
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Pierre & Miquelon
St. Vincent & the Grenadines
Sudan
Suriname
Svalbard & Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States Minor Outlying Islands
United States of America
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Wallis & Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Zipcode *
Best phone to reach you? *
2nd best phone to reach you? *
Spouse/Partner Phone (we must be able to reach all adults living in the home) *
E-mail Address: *
Current Vet Phone *
Current Veterinarian - Name & Location *
Past Veterinarian - Name & Location - BE SURE to list ALL Veterinarians used in the last 10 years
Past Vet Phone
Human Name Vet Account(s) is/are in (if not you, please state why) *
Neighbor Reference #1 - Name & Phone REQUIRED (Total of 3 REFERENCES REQUIRED including neighbor) *
Other Reference #2 - Name & Phone REQUIRED *
Other Reference #3 - Name & Phone REQUIRED *
Do you own or rent? * Own Rent
If rent or live with someone else who owns the home (including mobile home lot), Landlord's/Home Owner's Name & Phone is REQUIRED
Is your home * Suburb Home (some yard) City Home (very little or no yard) Country Home (acreage) Mobile Home Park Townhouse/Condo Apartment
Do you have a fenced yard? * Yes No
If yes, describe fencing (chain link, wooden, height, sq feet, etc..)
Do you have acreage? * Yes No
If yes, please describe (how much, at current residence or another location, etc...)
Do you plan to move? * Yes No
If yes, when & where (describe new home)
How many people are currently living in your home? Please provide Name, Relationship & Age for each (including yourself)? *
Does anyone in your household have allergies to animals? Please provide details.
If you have no children living at home, are there children who visit regularly ? * Yes No
What are the ages of these children?
What pets do you currently have or are living in your home or on your property? Please list ALL pets with pet names, species, ages, breeds...) for EACH or NONE *
Have you previously had pets? (please only list those that were your pets in your adult life) * Yes No
Please list all previous pets with name, species, breed, age & what happened to each pet that you had in your adult life(why you no longer have). *
Have you ever had to give up a pet? * Yes No
If yes, please give details why & what happened to each pet/where did each pet go...If No, put N/A *
Why are you looking for a new pet & what characteristics are you looking for? *
Why are you interested in this particular pet? *
Why do you feel you are ready for a new pet & why would you make a great home for this pet? *
Where will this pet be kept during the day or evening while you are away from home? Please provide details (exactly where - indoors, outdoors, confined to area, crated,etc..) Define the area. *
How long will the pet be alone, with no human companionship, each day on average? *
Where will your new pet sleep? *
Where will your new pet live? Please provide thorough details. *
How long will your pet be outdoors or in an out building (not in your main home) on average each day/night? *
If yard is not fenced, how do you plan to keep your new pet confined to your property (tie-out, dog run, dog pen, only on leash, etc..)? Please provide details of the 'system' you use to ensure your pets' safety. *
Who will be the primary caregiver(s) to this pet? (Name/Age) Please provide details of the primary caregiver's daily schedule (work hours, hours away from home, etc...)
What do you think it will cost per year to care for this pet? Please list expenses *
How often do you think your pet will need to see a veterinarian? Please detail reasons *
If your pet has or develops behavior issues (urinating, chewing, scratching, digging, excessive barking...), how will you handle? *
What amount of time do you consider reasonable for your new pet to adjust & adapt to his/her new life in your home? *
If something life changing should happen to you (other than death or needing to move into a nursing home/assisted living facility) which makes the pet an obstacle or inconvenience (i.e.-move, divorce, kids leave home, lose job, having children, etc…) what would you do? Please elaborate on individual circumstances you feel may affect your ability to care for or keep your pet. *
What circumstances might lead you to want to return your pet to us? *
Please tell us more about yourself, your family, your home, your neighborhood, your lifestyle, etc......... Your final 'sales pitch' to us that you are the 'right' home for this pet. *
Is everyone in the home 100% in agreement on & committed to this pet adoption? * Yes - 100% No
How did you hear about us? * I adopted from JR before From a friend who adopted from JR PetSmart - Orchard Park, NY PetSmart - Webster, NY Petfinder.com Web Search Vet's Office Facebook Olean Times Herald Show/Event JR was at From JR Volunteer PetSmart - Greece, NY Buffalo News Pet Supplies Plus - West Seneca Other
If you have previously adopted from Joyful Rescues, please provide name(s) when adopted and approximate dates.
The average life expectancy of a dog is 10-15 years and a cat is 15-20 years. Are you prepared to care for this pet for his/her entire life? * Yes No Unsure
You understand that if this adoption doesn't work out, you must return the pet to Joyful Rescues and there will be no refunds given. You fully understand the previous questions and you have answered them honestly. Applications are NOT 1st come - 1st served. Approvals are based on the best & appropriate home for each pet. Applications without 3 valid references & a vet reference (for pets owned the last 10 years) may be automatically rejected. * Yes No
VERY IMPORTANT - Please, BEFORE you SUBMIT your application, take a few minutes to review it and make sure your answers are honest and convey as you intended. Please leave no room for misinterpretation, as it will result in denial. As the saying goes, "Please say what you mean, and mean what you say." Thank you. By selecting YES, you confirm that you have reviewed your application and are confident that everything is accurate and exactly what you meant to convey. * Yes No
You also understand that Joyful Rescues has the right to deny or approve your application without question. * Yes No
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