P.O. Box 80663
Lincoln, NE 68501
402 - 476 - 4414
info@animalrescuesoc.org
Application For Adoption
Animal Rescue Society, Inc
P.O. Box 80663
Lincoln, NE 68501
(402) 476-4414
Animal Rescue Society Application & Adoption Agreement
Today’s Date______________
Animal(s) you wish to adopt_______________________
(Please answer all questions as completely as possible)
Name___________________________________________
Address___________________________ Own____Rent____How Long?__________
If renting, landlord’s name& phone #________________________________________
Phone
(Home)_________________(Work)_________________(Cell)____________________
Email address__________________________________________________________
Date of Birth_____________________
Drivers’s License #____________________________
Social Security #___________________________ (optional)
Marital Status_______________________
Employment/Student__________________________How long?___________________
Children – How many & what are their gender & ages?___________________________
Veterinarian’s name, address & phone (if currently have one)____________________________________________________________________
Who will have primary responsibility for this animal’s care?_______________________
Where will this animal be kept? Please describe______________________________________________
Do you have a safe yard area for the animal to go outside, weather permitting?_________
What do you plan on feeding this animal?______________________________________
Do you plan to spay or neuter this animal?_______________
If you are adopting a cat, do you plan to declaw it at some point?____________________
How many hours will this animal be alone each day?_____________________________
What do you plan to feed this animal? Dry Food (brand)__________Caned Food (brand)_________Other (chicken, roast beef, canned meat, baby food, tuna, mackerel, sardines, etc.)
Does anyone in your home smoke? (even if it’s outside) Y_____ N_______
Does anyone in your household have an allergy to cats or any other animals?________________________________________________________________
If someone developed an allergy to this animal, what would become of the animal?_________________________________________________________________
Have you previously owned any cats or dogs (or other animals)?_______ If so, where are they now?_______________________________________________________________
Other animals currently in household – Type, age & number of other pets____________________________________________________________________
Have you ever had a cat declawed? If so, what were the circumstances?___________________________________________________________
Have you ever turned an animal into a shelter? If so, what were the circumstances.____________________________________________________________
Have you ever had an animal put down? If so, what were the circumstances?___________________________________________________________
If you move, what will happen to the animal?___________________________________
If you have to leave temporarily, who will be responsible for the animal?_________________________________________________________________
What would you do if the cat suddenly stopped using the litter box (or dog began toileting on the floor for no apparent reason? ________________________________________________________________________
What will you do for flea control?____________________________________________
Do you understand about ear mites?___________________________________________
Do you have a firm understanding regarding dental health?_________________________
Why do you want to adopt this animal?________________________________________
Signature_______________________________
Date_________________________
ARS asks for a minimum donation of $30 for cats/kittens and $150 for dogs/puppies and $25 for all exotic and other animals. This donation may be tax deductible for the donator and provides insurance that the animal is not sold for profit.
Please read the following very carefully and very thoroughly:
I have given very careful consideration to the adoption of this animal. I understand that cats can live to be 30 years of age or more and dogs can live to be 20 or more. I assume total financial responsibility for this animal and understand this is a long-term commitment. If my situation would change and I would be unable to continue providing for this animal in a manner sufficient to maintain good health, balance and over-all well-being, I will return it to ANIMAL RESCUE SOCIETY. I will not pawn the animal off on someone else, dump it along a road or destroy it in any manner.
Additionally, if I feel compelled to have this animal put down for any reason I will contact and return it to A.R.S. I will first attempt to call them at the numbers listed below and, if unable to reach them by phone, will physically return the animal to the above address. If no answer, I will leave the animal on the porch in a pet carrier with all necessary information so that A.R.S. can make an informed decision regarding the animal. I agree that this animal will not be turned into a shelter or pound for any reason whatsoever.
I further understand that any animal I adopt, I will not allow it’s body to be mutilated in any fashion. This includes declawing, piercings, tattoos, cropping or any other type of alteration of it’s natural body, except for altering to prevent breeding. If I adopt a dog, I agree to present ARS with a certificate of obedience training within six months of adoption date. I realize I am responsible for providing veterinary care if the animal requires such and that I will take the animal in for regular checkups and dental cleanings at least every 6 months to 1 year. Further, I agree that I will not allow this animal to be over-vaccinated and will educate myself on the problems associated with such. The only vaccinations required by law are rabies, to be given only once per year or once every two or three years. Older animals should be excused from this routine and it is suggested you locate a veterinarian abreast of research demonstrating potential harmful affects of over-vaccination and the cessation after a certain age or when illness is present, which is clearly stated on the vaccine bottle.
_____________________________ __________________
Signature
Date
DatePH (402) 476 - 4414 / (402) 560 - 4198
Fax (402) 476 4414
**This application may be printed and mailed in for pre-approval or scanned and emailed to the above email address.
Thank you for your concern about these animals. Without people like you willing to give them homes our Organization could not exist.
