First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

County

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Driver's license number and issuing state for each adult in your household. (This helps us perform the background check and to locate you if you move and forget to update the microchip and your pet gets lost)*

Date of Birth (for each adult in your household)*

Employer name (if you are retired please enter retired) *

Employer phone number (if retired please enter retired)*

How long have you been employed here? *

What is your occupation?*

Do you give Katie's Roadside Rescue permission to conduct a CRIMINAL BACKGROUND CHECK? The purpose of this check is to make sure that the dog will be safe and that there are no animal cruelty cases. *

Please list the number of those living in your household. *

Please list the names and ages of each member of your household. (This helps us determine if the pet you are interested in is a good fit, not all dogs are good with young children)*

Who will be the primary caregiver for your new pet?*

How many hours do you estimate your new pet will be alone during the day?*

Where and in what method will the animal be maintained when you are not home?*

Where will your pet spend the majority of his/her time?
Choose all that apply: Inside Only Outside Only Inside and Outside

Ideally, where will your pet sleep at night?*

How do you feel about chaining your pet?*

What specific traits are you looking for in a pet? (This will help up determine if the pet you are interested is a good fit for your family)
Choose all that apply: Male Female Baby (up to 6 months) Young (up to 2 years) Adult Companion Protective Companion for another pet Active (running, walking) Couch potato Average energy

Please provide your veterinarian's name and phone number for each veterinarian you have used the past 5 years including specialty vets. (Please do not list a vet you "plan to use", if you have not had animals previously and do not have an established vet please state so.) *

Please select the animal you are interested in.
Choose an animal: Bruce Julio Lulu Schooner

What prompted you to look for a pet at this time?*

Have you applied with any other rescues?

How did you hear about KRR?*

Do you currently have pets? If yes, please list their names, approximate ages, and breed (dog, cat, etc.)*

Please list all of the pets you have had over the past 5 years. If a pet is no longer with you, please tell us what happened to him/her. (Please enter N/A if you have not had pets)*

Is/was your pet current on heart worm prevention?

If your pet is not/was not on heart worm prevention please explain why not.*

Do you spay/neuter your animals? If no, please explain. *

What are your training methods for chewing? house training? barking?*

Is your yard fenced

What is the height of the fence*

What type of fence?
Choose all that apply: Privacy Chain Link Invisible Basket Weave Other Cow/Hog panel

If you don't have a fence please explain the plan for potty breaks and exercise as well as in inclement weather. *

Do you know what brand of food you will feed your pet? If yes, please list. If no, please tell us what foods you would consider. *

Are you willing to learn about healthy foods for your dog?

Please provide the history of animals you have had and what happened to them.*

Do you own or rent your home*
Choose one: Rent Own

If you are a homeowner do you have a HOA?*

Will the adoption of another pet(s) be in compliance with your HOA rules, regulations, and guidelines?*

In what type of home do you live?
Choose all that apply: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Are/were your companion animals current on their vaccinations?

Are you financially ready to adopt a pet at this time and provide for it's care and medical necessities? *

Do you agree to permit KRR to perform a home visit?

Are you planning to move in the near future?*

What are your plans for the pet if you have to move?*

Most rental properties have pet policies, please provide your landlord's name and phone number so we can help you identify a pet who fits your lifestyle and your property's pet policy: (If you own please write "own")*

If you rent, have you received the approval of your landlord to have an animal

If you are unable to keep the pet adopted from KRR for any reason, do you promise to return him/her to KRR and assist with transportation back if necessary? *
Choose one: Yes No

Please list any foreseeable reasons you would not be able to keep your pet: *

Please provide the first & last name, phone number, and email address of 3 personal references not living with you. *

I certify that the information provided within this application is true and correct (please enter your name and date):*