Rural Iowa Animal Rescue Adoption Application

Which animal are you applying for?

* Names of adults in the household

* Birthdates of adults in the household

* Address (street, city, state, zip code)

Cell Phone #

Home Phone #

Email address

Employer and how long

* Do you own or rent your place of residence?

If you rent, please provide landlord's name and phone #

Ages of children in the household

* Have you adopted from a shelter or rescue before?

* Have you ever been refused adoption from a shelter or rescue before? If so please explain.

* Please explain why you would like to adopt this pet.

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Please list the pets you currently own or have owned in the last five years.

Pet #1

Kind of pet (dog/cat/rabbit/etc.) and breed if the pet is a dog.

Age and sex of pet

Is the pet spayed or neutered?

Do you still own this pet? If not why?

Please list the pets you currently own or have owned in the last five years.

Pet #2

Kind of pet (dog/cat/rabbit/etc.) and breed if the pet is a dog.

Age and sex of pet

Is the pet spayed or neutered?

Do you still own this pet? If not why?

Please list the pets you currently own or have owned in the last five years.

Pet #3

Kind of pet (dog/cat/rabbit/etc.) and breed if the pet is a dog.

Age and sex of pet

Is the pet spayed or neutered?

Do you still own this pet? If not why?

Please list the pets you currently own or have owned in the last five years.

Pet #4

Kind of pet (dog/cat/rabbit/etc.) and breed if the pet is a dog.

Age and sex of pet

Is the pet spayed or neutered?

Do you still own this pet? If not why?

* Who is your vet or the vet that will be used for this pet? (Name and phone #)

What shots has your current pet had in the last year?

What was your current pet's last vet visit for and when was it?

* Do members of the household have allergies to pets? If so please explain.

* If you move in the future what will you do with your pet?

* Do you have a fenced in yard?

If not do you plan to fence your yard?

* Describe the area thar you will keep this pet (shed, stall, pasture, etc.)

* Describe your water source.

* If applying for a horse, who is your farrier (name and phone number)

* Who will care for the pet when you are out of town?

* Animals are as individual as humans are. Are you willing to spend the time, effort, & patience required to help this pet adjust to its new home, family, & lifestyle? (It can take days or even weeks for a new pet to adjust)

* Have you had pets in the past that you have sold or given away? If so please explain.

* Under what circumstances would you not keep a pet?

* If there were circumstances beyond your control that forced you to give up this pet, would you agree to contact us BEFORE placing the pet in another home?

* What type of pet are you looking for?

* Would you agree to a farm/home inspection as part of the adoption process?

In adopting this pet, the owner agrees to:

1. Accept and keep the animal as a companion.

2. Provide humane care – giving pet proper food, water, shelter, exercise, and attention.

3. See that a veterinarian gives this pet regular preventative care and immediate medical attention when it becomes ill or injured.

4. Not permit the animal to be used for vivisection or experimentation.

5. Comply with all state, county, and municipal laws pertaining to animals.

6. Indemnifies and holds harmless Rural Iowa Animal Rescue for any damages which the pet may do to any person or property.

7. Return the animal to Rural Iowa Animal Rescue if it can no longer receive adequate care (food, shelter, affection and attention).

8. Understand that adopting an animal is a 12-30 year commitment.

9. If not already done, spay or neuter the pet within 30 days (if applicable).

Should a medical problem develop within seven (7) days, the animal may be returned with a veterinarian’s statement regarding the problem and the adopter may request their adoption fees be refunded.

Rural Iowa Animal Rescue is not responsible for any expenses incurred in treating the animal.

RURAL IOWA ANIMAL RESCUE reserves the right to REFUSE adoption of an animal to a home that does not meet the above standards. This includes the right to follow up animal adoptions and remove the animal if:

1. The animal is not receiving adequate care.

2. The animal is being abused.

3. The animal is penned outside day and night or housed in a garage or out building all the time with no human interactions.

ALL SHOTS, MEDICINE, VERTERINARY EXPENSE, BOARDING, AND OTHER LIABILITY OBTAINED AFTER ADOPTION ARE THE SOLE RESPONSIBILITY OF THE OWNER.

If the following statement is checked, it applies to the animal I am adopting:

_______I have been fully informed that the animal has previously bitten someone and assume any and all risk for the animal and indemnify RURAL IOWA ANIMAL RESCUE and hold it harmless for any further actions of this animal.

By signing below I certify that I have read all the above information and have provided all true information. I recognize that any misrepresentation of facts may result in my losing the privilege of adopting or keeping an adopted pet. I understand that Rural Iowa Animal Rescue has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application. I understand that this application is the property of Rural Iowa Animal Rescue.

Signature of Applicant

* Indicates Response Required

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