Rescue Rehabilitate & Rehome
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____________________________________________ Dog Name:_______________
PHONE ____________(home) ________________(work)
EMAIL ADDRESS ____________________________________
Why do you want to adopt a pet?
Who will be the primary caretaker of this pet:_____________________________________________________
Is there anyone in the home who may be adversely affected by care of dogs/cats
Do you live in a..
Do you: Own_____ Rent_____
Do you have the landlord�s permission to have a
Landlord Name/Phone #_______________________________________
Do you have a fenced yard? _______ Yard Size ___________Type and height of fence?___________________
Where will the animal be kept during the day? ____________________ At night? __________________________
Will this be your first pet?_____________ List any other pets you have, if they are on heartworm preventative and if they are spayed or neutered:
Do your pets get along with other animals?__________________________________________________________________________________________________________
Have you had other pets in the last 5 years and what
Are your pets up to date on vaccinations?_________ May we contact your veterinarian? ________ Please provide name,
address and phone # of most recent veterinarian: _______________________________________
Are you prepared for the expenses of yearly boosters,
emergency medical care and routine care for possibly
Adults in the home_______ Children in the Home _______
Children�s ages __________________ Do all members of
household want to adopt this pet? ___________
How long have you lived at your present location?
Do you anticipate moving in the near future? _______________________________________
Are you willing to make a lifetime commitment to this pet? _____________________________
Applicant�s Signature Case Manager. Signature
Approve:____________ Denied:______________ Reason for Denial: _________________________________
Please mail your adoption form directly to
DogsOnly, P.O. Box 251412,
Little Rock, AR 72225-1412.
If you prefer you can fax your application to 501-833-0820