Adoption Application

Patches Animal Rescue, Inc.

WI Boxer Rescue, Inc.

Thank you for submitting an application! Provide as much information as possible and complete all the required fields (*).

**We respond to form submissions within 48 hours. If you do not hear from us fwithin that time, email kwaugus@yahoo.com .

Name of pet you are applying for

Speciies

Dog

Cat

Applicant Information

Applicant #1 First/Last Name

Age of Applicant #1

Applicant #2 First/Last Name

Age of Applicant #2

Street Address

City / State / Zip

Email. (Verify accuracy! Main means of communication)

Phone

Do you have children under 12 in the home or who frequent your home?

Yes

No

Other

Is your household busy or quiet?

Busy (lots of activity, people in/out)

Quiet (not many visitors)

Other

How many hours are you gone a day? How many hours will this dog be home alone?

Who is the primary caretaker of your dog/pets?

Is this your first pet?

Yes

No

Information About Your Pets

List the pets you have owned in the last five (5) years. Provide their name, species, age, spayed or neutered, where you got them from (name of rescue/shelter/breeder) and if they are still with you. We will need to verify that they properly vetted.

If you need more space, please fill in "other" below.

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Dog Training and Cues

If you've had a prior/have a current dog, you taken your dog to training classes or work with a trainer?

Yes

No

Other

If Yes, provide business name or name of trainer(s) and location.

Do you believe in crate training dogs?

Yes

No

Other

Health Information

Proviate the name of all veterinarians that you have used in the last five (5) years. We will contact your vet to verify your current and past pets have been seen annually, sterilized, vaccinated, heartworm tested, etc.

Name of veterinarian/location/phone

Date of last vet exam

Do any of your past or current pets had/have any medical considerations? Health problems?

No

Yes, Please list.

Provide any additional information or anything you'd like us to know. You can also attach information at the end of this form.

Please read and check each box.

As the applicant(s) listed above, I/we agree the information provodied is true and accurate to the best of my knowledge.

I give Patches Animal Rescue, Inc or WI Boxer Rescue, Inc. permission to contact the veterinarian(s) listed above.

I understand that if I have ommited any necessary information this might affect my ability to adopt

I verify that I am over 21 years of age.

By entering your name below, you acknowledge you have read and understand all the above statesments.

Proof of vaccinations/other attachments

Proof of vaccinations/other attachements