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Journey Animal Rescue Adoption Application The Long Journey Home to a New Beginning Please answer the questions below and click on the Submit button to send us your adoption application     ** indicates the field is required   Name of the pet you are applying for   **       Your Contact Information Name:  **      Address:  **  City: ** State: ** Zip: ** Home Phone: ** Alternate Phone: Email Address **   Physical Address (if different then the one above) Address: City: State: Zip: Additional Contact Comments   Tell us about your Residence **Rent        Own   If rent, please give us the name and phone number of your land lord ** Name:       Phone:      Number of years at this address: ** Will you be moving soon? ** Yes       No   If yes, what will you do with your pets ** Do you have a yard? ** Yes       No   If yes, is it fenced? ** Yes       No   Type of fence **      Height ** Are you familiar with animal control laws in your area?       Additional Comments About your residence:   Tell us about your household and family Number of adults in household:  **      Number of children in household  **     Ages?  **      Does everyone in the household agree to the adoption of this pet?  **   Is anyone in the household allergic to animals?  **   Do you have an active or quiet household?  **   Additional Comments About your household and family:   Tell us about your current and past pets List all current pets in your household **: Please give name, species (dog,cat,horse,etc), breed, M or F and spayed or neutered? and age of pets List all pets/animals you have owned in the last 5 years that you no longer have **: Please give name, species (dog,cat,horse,etc.), breed, Male or Female, spayed or neutered, Age, where the pets are now (re-homed, deceased,lost,etc). Please provide detail if re-homed or, if they died, circumstances of death. Name and phone number of your current or previous veterinarian **: Name:       Phone:      Have you ever given an animal away? If so, under what circumstances. If not, under what circumstances yould you give up your pet? **   Tell us about the pet you are applying for Why do you want to adopt this pet?  **   Companion, guard dog, hunting, breeding,etc Are you willing to spend the time adjusting your pet to its new environment and working through problems as they arise? ** Where will this pet be kept when you are home?  **           Where will this pet be kept when you are not home?  **    Where will this pet be kept when you have to go out of town?  **  How will your pet be kept outside?  **  How will you exercise this pet?  **        How many hours per day with this pet be left alone?  **  Are you planning or willing to take this pet to training classes?  **  Are you able to provide for your pets medical expenses?  **        Understanding that a dog may live up to 17 years, are you willing to make that committment for the life of your pet? ** Additional comments about why you are applying to adopt this pet: Name and phone number of a personal reference ** Name:       Phone: