Surry Animal Rescue

Mount Airy, NC

Adoption Application

Application MUST be completely filled out or it will not be processed. We are not able to contact individuals for the missing information. After the application has been received and reviewed, someone will be in contact with you within 2 weeks.
Date of Application Name of Animal YOUR INFORMATION
*First and Last Name *Home Address including city, state and zip code Home phone# Cell phone# Employer Work phone# Normal work hours? *Email Address

SPOUSE/PARTNER INFORMATION

Name Cell phone# Employer Work phone# Email Address VETERINARIAN INFORMATION
Name Address Phone#

CURRENT PETS
Please answer the following questions for each animal:

Name

Dog/Cat & Breed

Sex

Spay/Neuter

Current vaccines

Age

Length of ownership

Indoor/Outdoor

Fill in your pet's information below. We have provided you an example.

PAST PETS

Please answer the following questions for each animal:

Name

Dog or Cat & Breed

Sex

Spay/Neuter

Vaccines Y/N

Age

Length of ownership

Reason and Date

Fill in your pet's information below. Use the example above.

GENERAL INFORMATION

*What is the best time to reach you by phone? *Why do you want to adopt an animal from our rescue? *Are there children living in your home? If so, please list their name(s) and age(s). *Do you own or rent? (house, apartment, mobile home) *Is your home located near a busy road or highway? *Does anyone in your household have pet allergies? *What arrangements would you make for your pet when you are traveling? *Do you plan on breeding any animals? *Who will be responsible for the care and costs of the animal? *Have you applied to other rescues or shelters in the last 6 months? *Have you ever surrendered an animal to a shelter or rescue? If so, please explain.

IF INTERESTED IN ADOPTING A DOG
PLEASE COMPLETE THE BELOW INFORMATION

Do you have a fenced in yard?
Yes
No
Describe your fence; height and type If not, are you willing to: (please check all that apply)
Build a fence
Install a pen or run
Leash walk at all times
Will you be keeping the dog indoors or outdoors?
Mainly indoors
Mainly outdoors
Both
Are you willing to do training; including housebreaking?
Yes
No
Yes, but not housebreaking

IF INTERESTED IN ADOPTING A CAT
PLEASE COMPLETE THE BELOW INFORMATION

Will you allow the cat to go outside? Why or why not? Are you willing to litter box train?
Yes
No
Are you going to declaw? Why or why not?

REFERENCE

Name and relationship Home phone# Is this person a pet owner?
Yes
No

PLEASE INCLUDE ALL QUESTIONS AND COMMENTS BELOW: