ANIMAL GUARDIANSHIP APPLICATION

CARING-LEARNING-CONNECTING RESCUE AND REHABILITATION

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This questionnaire is designed to help us get to know you and your situation better in an effort to create an outstanding match between you and your new animal companion! Please answer each question as honestly as you can, and do not assume that a certain answer will disqualify or assure approval!

  1. Name(s) of person(s) applying for guardianship: ______Address:______Home Phone:______Work Phone:______Cell Phone:______Email______
  2. Please check the reason for filling out this application and give a brief description of what prompted you to do so. foster adopt ______
  3. Name(s) of animal you are interested in adopting or fostering (if specific): ______
  4. Species or Breed of Animal you prefer: ______
  5. Gender preference: Male______Female:______
  6. Age range preference:______
  7. Do you rent or own? ______
  8. Please describe your property (including fence type, kennel or corral set up, acreage, trees/shrubs, landscaping, access to outdoors for smaller pets, and barn or shelter for livestock companions): ______
  9. If you rent or have a community association that governs your ability to own pets or livestock companions please give the contact information: ______
  10. Please list names of adults in household full and part time and ages: ______
  11. Please list names of children in household full or part time and ages: ______
  12. Please list the names and types of other pets/animals in household and ages: ______
  13. Primary caregiver of the animal you are applying for: ______
  14. How will this animal be exercised? ______
  15. Where will the animal be housed during the daytime? yard house

crate corral pasture other (please give details)______

  1. Where will the animal be housed at night? yard house crate corral pasture other (please give details) ______
  2. What type of food are you planning to feed your new companion? (check all that apply and follow with details) raw kibble grain-free homemade hay/grain/pellets supplements/vitamins/etc. treats ______
  3. How will you plan to confine your companion safely outdoors? ______
  4. What types of vehicles do you own and how do you transport animals when needed? ______
  5. Who cares for your animals in case of an emergency where you must leave or on vacations where you can’t take them along? ______
  6. How many hours per day will your animal be alone? ______
  7. What types of training would you be willing to provide your new companion with? ______
  8. What types of activities do you participate in that would include your new companion? For instance- hiking, hunting, agility, barrel racing, trail, nose-work, camping, frisbee, fetching, 4-H competitions, obedience, showmanship, etc. ______
  9. Under what circumstances would you consider surrendering an animal? ______
  10. What would you consider your level of experience with the type of animal you are applying for? experienced somewhat novice (please give details if you wish) ______
  11. What characteristics or temperament are your expecting of this companion? ______
  12. What type of energy level do you prefer? couch potato/laid back or lazy energizer bunny/busy somewhere in between (please give details if you wish) ______
  13. Please list names and breeds of any pets/livestock companions that you owned in the past ten years that you no longer have, the age at which they left your life, and the reason (death, rehomed, lost, stolen, etc.) that they are no longer with you:______
  14. Do you agree to a home/property check? ______
  15. Are you interested in a special needs animal (for instance one the might require medications or intensive training for fear or socialization)?______
  16. Are you interested in fostering an animal now or in the future? ______
  17. Are there any additional comments you would like to share with the application reviewer and/or committee? ______
  18. Please list your employer and their contact information: ______
  19. Please list three references and their contact information; one personal, one family, and one who knows you as a caregiver for pets or animals (this could be a groomer, dog walker, trainer, fellow pet/livestock owner, etc): ______
  20. Please list the contact information for your veterinarian: ______
  21. Can you afford a veterinary bill of at least $500 and in excess of $2000? ______

Caring-Learning-Connecting Rescue and Rehabilitation asks for a rescue donation to help defray the costs of spay/neuter, vaccinations, various required testing, microchipping, training, or other foster and transport costs that we incur. Submission of your application does not guarantee placement of a companion animal. Applicants must agree to a home visit if requested. The rescue donation is due at the time of placement.

A rescued animal may have experienced neglect, abuse, abandonment, social isolation, insecurity, or other unfortunate traumatic history that could create a need for an adjustment period to a new home. Often the animal is so grateful for the display of love and affection that is shown by an adoptive family that they will relax and immediately begin to repay the kindness and consistent benevolence with loyalty, affection, eagerness and willingness to please and unlimited devotion.

I UNDERSTAND THAT MISREPRESENTATION OF FACT MAY RESULT IN THE REMOVAL OF A PLACED ANIMAL FROM MY HOME OR PROPERTY. I UNDERSTAND THAT CARING-LEARNING-CONNECTING RESCUE AND REHABILITATION IS NOT RESPONSIBLE FOR THE ACCURACY OF INFORMATION RECEIVED ABOUT THE TEMPERAMENT, HABITS, OR PHYSICAL CONDITION OF THE ANIMALS AVAILABLE FOR ADOPTION. CARING-LEARNING-CONNECTING RESCUE AND REHABILITATION IS NOT LIABLE OR RESPONSIBLE FOR ANY DAMAGE, INJURY, OR ACCIDENT RESULTING FROM THE PLACEMENT OF THIS COMPANION ANIMAL.

I WILL ACCEPT ALL RESPONSIBILITIES FOR THE HEALTH, HOUSING, FEEDING, RECOMMENDED TRAINING, AND COMPANIONSHIP OF THIS ANIMAL (with the exceptions outlined in a foster agreement and listed on the foster addendum).

Guardian Signature(s) ______Date______

______Date______

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