Adoption Application

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Starfish Rescue

A Rescue Community – Tomball, TX

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Animal Name

Gender

Your Name *

First

Last

Your Address

Driver's License Number

Date of Birth

Phone Number

Email *

Address where pet will live

Who will be responsible for pet?

Have you ever owned a dog before?

Yes
No

If yes please tell us what happened to your previous dogs.

Do you currently have any pets?

Yes
No

If yes please list all current pets and ages.

Are they spayed/neutered?

Yes
No

Are your pets vaccinations current?

Yes
No

What type of heartworm prevention do you use?

Are you familiar with heartworms and heartworm prevention?

Current Vet – Name/Address *

Current Vet Phone Number

May we contact your veterinarian for a reference?

Yes
No

Please call and give authorization for them to speak with us.Please call and give authorization for them to speak with us.

Do you have a fenced yard?

Yes
No

Type of fencing

Will your pet be kept indoors or outdoors?

How long will your pet be left alone on a daily basis?

Do you have children in your home?

If yes, please provide the ages of children.

Does anyone in household have animal allergies?

Does everyone in the household agree on adopting this pet?

If you rent your home we will need to contact the property owner/manager please provide contact information.

Please provide Property owner/manager name and phone number.

Do you agree to a home visit by a rescue volunteer?

Yes
No

Under what circumstances would you find it necessary to find a new home for your pet? *

Most shelter/rescue dogs have unknown medical histories. Are you willing to take your new dog to a veterinarian for an initital exam and any necessary treatment at your own expense?

Yes
No

Why do you want to adopt this pet? *

Please check each line below indicating your understanding, agreement and acceptance:

Any adoption fee is NON-REFUNDABLE.
You will return the animal to us if you feel you cannot keep him/her. You cannot sell or give the pet to anyone else, or surrender pet to a shelter.
You have the ability to care for your pet and your pets needs financially.
Your pet MUST be vaccinated.
If requested you will furnish Rescue with proof of current vaccinations for a 24 month period following adoption.

Checking the box below certifies that the above information is true and correct to the best of your knowledge. Any false information will lead to the denial of your application. The Rescue reserves the right to annul the adoption and reclaim the animal for any falsification of information or failure to follow all agreements contained in this application after the adoption. The adoption decision is based on many factors. The Rescue reserves the right to refuse any adoption at our discretion. Your signature certifies that the above information is true and correct to the best of your knowledge. Any false information will lead to the denial of your application.

I Agree

Yes
No

Name