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Who are you interested in? (please include the letters that appear in parentheses on the listing, if any.)

Your Name (required)

Your Email (required)






You and Your Family

1. Number of adults in the household

2. Number of children in the household

3. Does anyone in your family have allergies?
 Yes No

4. Would this be your first pet?
 Yes No

if yes skip to question 10

Your Pets

5. Please list all current pets, including - type of pet, breed, age, sex, spayed/neutered status, indoors or outdoors pets:

6. What type of heartworm/flea prevention is your pet?

7. When you are not at home, where does your pet(s) stay?

8. Are any of your pets considered aggressive?
 Not aggressive With other animals With men With women With children

9. Tell us about any previous pets, did you give them away?

Choosing Your New Pet

10. Who will be making the decision to adopt this pet?

11. Why do you want to adopt this pet/breed?

12. On a scale of 1 (quiet) to 5 (high energy),what activity level are you looking for?

Taking Care of Your New Pet

13.Where and with whom will your pet spend most of his/her time?

14.Where will the pet be when you aren't home?

15.Where will the pet sleep?

16.What type of house training methods will you use?

17.How will you discipline your pet?

Where You Live

18. Do you live in

19. Do you:

20. What kind of area do you live in?

21. Do you have a fenced yard?

22. Do you agree to a home visit by one of our representatives?(required)

 yes no


23. Where did you hear of Animal House Rescue

24. Please list the Names, Addresses and Phone Numbers of 3 References.
(Important: At least 2 of these can NOT be relatives.) (required)




25. Do we have permission to contact your references?(required)

 yes no

26. Please list your current vet or the vet you intend to use (required)

27. Do we have permission to contact your vet?(required)

 yes no