The following application may be copied and pasted into your document folder and then inserted into an email. Mail to

Name of Applicant:


Name of Co-Applicant:


Street Address:


City:                                                                                 State:


Zip Code:

Driver License #

Home Phone:                         Cell Phone:                              Work Phone:                  


Email Address:


Best Number and Time of Day to Contact:


Applicant Occupations and work schedule:



Are you aware that routine costs to maintain a pet average $500.00 to $800.00 dollars a year?    Yes________    No_______




Please list all members of Household excluding pets and ages of each:







Please List all pets in Household:



Are all pets in the household spayed and/or neutered: Yes_____ No_____

If answered No, please indicate status of pet:


Are all dogs in your household on year round heartworm preventative?

Yes_______No______  Name of Preventative:____________________________


Other than children living in the Household, will your pet come in contact with other children under the age of 5 (i.e. neighbors, grandchildren)?

Yes___________No__________ If yes, what ages?______________________


Do any elderly or physically challenged people live with you or visit frequently?



Is the house that you live rented or owned?____________________________


If you rent, do you have your landlords permission to own a pet?____________

May we contact your landlord to verify permission? Yes________No_________

Name of Landlord:___________________________________________________



Do you have a fenced yard?  Yes_______No___________

Please describe fence (height, condition, etc):____________________________________________________________________________________________________________________________________________




Do you have a Dog Door:    Yes_________No_________




Will this be your first Pet?  Yes_______No_________

What breed(s) of Dogs have you been companion to?



Have you ever bred a pet? Yes________No________

Have you ever sold a pet?  Yes________No________

Have you ever given a pet away? Yes________No__________

Have you ever surrendered a pet to a shelter?  Yes_______No___________

Please explain circumstances if Yes to any of the preceding questions



Do all Members of the family want a Pet?   Yes________No______


Please tell us the reason you want a Pet.


Why do you think you would be a good caregiver to a pet?


________________________________________________________________________________________________________________________________________________What What age pet fits with your lifestyle and expectations?_________________________

Are you aware that some pets are very active? Yes________No________

Do you have time and are physically able to give active pets adequate excersise?


Are you aware that all pets shed year round?  Yes________No_________

Is anyone in your home prone to allergies or may be adversely affected by a pet?


Describe activities that your pet would be included (i.e. swimming, family outings)


Is anyone home during the day? Yes____No____  Age_______

How long will the pet normally be left alone during the day?____________________

Where will the pet be kept during the day when no one is home?___________



When you transport/travel with your pet, will they ride in a car, truck or both?


If you answered truck or both, how will you restrain your pet to prevent accidents such as falling out or being tossed out?_________________________________


__________________________________________________________________               What provisions can you make for your pet if you become sick or hospitalized?

________________________________________________________________________________________________________________________________________________________________________________________________________________________What What will happen to the pet if you get married, get divorced or have children?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If If you move, what will you do with your pet?_________________________________

________________________________________________________________________________________________________________________________________________Are Are you familiar with the use of a dog crate to confine the pet during any absence, for their safety, as an aide in housebreaking or to provide a safe haven?_________________________________________________________________________________________________________________________________________________________________________________________________________________Where Where will your pet sleep at night?__________________________________________


Please check all the following that will apply to your pet:

Will your pet:

Have the run of the house? Yes_______No_______

Be in blocked off parts of the house? Yes________No_________

Be crated? Yes______No______

Be tied outside? Yes________No________

Live in a fenced back yard? Yes__________No________

Live mainly  in a dog run? Yes________No________

Roam loose in the neighborhood? Yes________No_________

If you are adopting a cat, will the litter box be kept inside? Yes______No______

Will the cat be declawed?  Yes________No_________

Will the cat be allowed to go outside? Yes_______No_______

For Peetey's Sake believes it is important to be aware of laws governing the ownership of a pet. Are you familiar with your local, county and state laws?



May we visit your home prior to application approval? Yes_____No_____

Please indicate the best day and time for a home visit:__________________________

May we contact your veterinarian?  Yes_______No________

If yes, provide contact information of most recent vet:




Our volunteers may take up to two weeks to complete the application process, are you willing to wait?  Yes_______No______



Answers are expected to be complete and truthful, as they will enable us to better comply with your requests and requirements. Failure to provide accurate information can result in revocation of the adoption at any time by For Peetey's Sake Dog and Cat Rescue By completing this form the undersigned(s) expressly give permission to 

Peetey's Sake Dog and Cat Rescue 

to verify the information contained in this application, and further release For Peetey's Sake from any and all liability associated with this application or the adoption process.

I/We attest that the Terms and Conditions of Adoption, as stated above, have been read in full by Me/US and I/We understand that these terms constitute a part of the adoption agreement between Me/Us and 

Peetey's Sake Dog and Cat Rescue 

and will be enforced.

Terms and Conditions have been read?  Yes_______ No_______


I/We attest that information provided on this application is true and accurate to the best of My/Our  knowledge.  I/We understand that completion and submission of this application does not guarantee adoption of a pet. If application is submitted electronically, I/We further attest that no changes have been made to the content of this document and understand that my approval by signature is assumed and agree to transmit a signed original or facsimile prior to any decision by 

Peetey's Sake Dog and Cat Rescue

on my adoption application.


Applicant Signature:_______________________________________Date_________

Co Applicant Signature:_______________________________________Date_________


Submission of an adoption application does not guarantee an adoption of a pet through 

Peetey's Sake Dog and Cat Rescue


Thank you for opening your home and heart to a rescued pet.