Second Chance Pet Society, Inc

Second Chance Pet Society, Inc.

We need to know as much about you as possible. Each question you answer on this application will help us better serve you and a rescued pet. Please be honest with your answers on the following questions. The information is to help us determine the best possible match for you as well as for a rescued animal in our care.

There are no right or wrong answers and you will not be disqualified because of any answer you give. Also, your cooperation in answering all of these questions will help speed the process. Thank you!

NOTE: Second Chance Pet Society, Inc reserves the right to refuse any application to adopt for any reason.

Name:______

Address:______

City/State/Zip:______

E-Mail Address:______

Place of Employment:______

Daytime Phone:______

Evening Phone:______

Best Time To Call: Daytime Evening

What is the best way to contact you? Phone Email

Type of Home: Singlefamily Apartmentor Condo

Do you rent or own your home: Rent Own

Does your landlord allow pets?: Yes No

How many adults live in the home? _____

How many children live in the home? _____

What are the children's ages?:______

Do you have other pets?: Yes No

If yes, please list types and numbers: (Please include fish, birds, hamsters, etc:)______

______

Does anyone in your home haveallergies? Yes No

Do you have a family Veterinarian?: Yes No

If so, please list his/her Name,Address and Phone Number:

______

______

How many hours will this dog spendoutside in a normal day:______

Have you ever adopted a rescuedanimal?: Yes No

How will you exercise your adoptedcompanion?:Fenced yard, Walk your dog, Hire a dog walker

When you are home, where will the dogbe kept? Loose indoors, loose outside, crated, confined to one room or sectionof the house.

What do you expect in the temperamentof your rescue pet?:______

______

______

If there is a pet on the rescue pagethat you are interested in adopting, please tell us which one and why? ______

______

______

Do you travel frequently? Yes No

If yes, who will care for your petswhile your aretraveling?

______

______

Have you carefully considered the financial cost of pet ownership and are you financially prepared to give your pet theroutine medical care it requires? Yes No

Have you ever owned a dog in the past? Yes No

Have you ever bred a pet in the past? Yes No

I understand that a home check will berequired before the adoption is final.

To the best of my knowledge the aboveinformation is accurate.

Please email this completed form