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 Verification Code:
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