TEARS - The Emergency Animal Rescue Service

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Pre-Adoption Application

Thank you for your interest in a rescue pet. Our goal with this questionnaire is to get additional information to make sure there is a compatibility between the animal & potential home. By answering these questions thoroughly & honestly we will be able to determine if the animal you are interested in would be a good fit for you & your lifestyle.

Please fill out this form in its entirety to be considered for a future adoption! Thanks!

Name of Animal Interested In:
Your Name:
Home Phone:
Work Phone:
Address: (Including City, State, Zip)
Email Address:

Please check any of the following reasons you are considering adopting a pet:

Companion for Self
Companion for Another Pet
Child's Pet
Hunting Dog

Guard Dog/ Watch Dog
Barn Cat/ Mouser
Breeding
Gift

Are there children in the household?

Yes No

If so, what are their ages?

I live in a:
House Apartment Condo Town Home Mobile Home

Do you rent or own?

Rent Own

If you rent:

What is the name of your apartment or landlord and their phone number?

Does your lease allow pets?

Yes No N/A

What is the weight limit?

How long will the pet be home alone on the average day?

Where will this pet be living?

Inside Out Both

Do you have a fully fenced yard?

Yes No

Is the fence attached to the house?	Yes No
What is the height of the fence?
What is the fence made out of?
What is the size of the yard?
Have you ever found it necessary to chain or tie out your dog?	Yes No
If yes, please explain why:
Have you ever had a hard time keeping a dog in your fence?
If yes, please explain why:

What kind of shelter will the pet have while outdoors?
(Alabama law defines shelter as 3 sides, a top and a bottom)

For which of the following reasons would you give up your pet?
Please check all that apply:

Moving
New Baby
Not getting along with children
Not getting along with other pets
Divorce
Getting out of fence
Financial
Behavior problems
Aggressive

Too big
Too time consuming
Shedding
Allergies
Excessive Barking
Medical problems with pet
Other:

Have you ever surrendered an animal to an animal shelter/pound/humane society?

Yes No

If so, explain:

Has a pet died while living in your care?

Yes No

If so, explain:

Please answer the following questions honestly:

Have you ever had a pet stolen?	No Yes (please explain):
Have you ever had a pet poisoned?	No Yes (please explain):
Have you ever had a pet killed by a vehicle?	No Yes (please explain):
Has a pet of yours ever died form a disease?	No Yes (please explain):
Would you allow a dog to ride in the back of a truck?	No Yes (please explain):

Do you currently own a pet?	Yes No
In the last 5 years?	Yes No
If so, how many and what kind?
Current pet(s) names:
Are your pets spayed or neutered?	Yes No
If they are not, what is the reason?
Do your pets live: Indoors Outdoors Both Other:
Are your pets current on all shots?	Yes No
Are your pets on heartworm preventative?	Yes No
If yes, brand name of Heartworm Preventative:
If not, what is the reason?
Will you be taking your new pet to the vet for full prevention and medical care once a year?	Yes No
Please provide your Vet Clinic that you take your current pets and would take your new pet.
Phone number of above Vet Clinic:
Do you mind if we call your vet for a reference?	Yes No
Account Name at Vet Clinic:
Would you object to an authorized TEARS representative inspecting the animal you are considering adopting in addition to the premises where the pet would be living?	Yes No

I attest that the information I have provided here is true and accurate. I understand that if any portion is erroneous or misleading it may cause or lead to the confiscation of the animal.