Adoption Application
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To help ensure the best possible placement of our rescued pets, and in order to determine the the proposed adoption is in the best interest of the animal, you and your family, please complete each of the following questions. Please be as thorough as possible. Up-Cycled Pets reserves the right to refuse adoption to any applicant.
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| Your Name
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| Prefix
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| First
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| Last
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| Suffix
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| Your Spouse's Name
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| Prefix
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| First
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| Last
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| Suffix
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| Your Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Home Phone
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| Other Phone
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| Your E mail
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References
Please list 2 personal references that we may contact.
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| Personal Reference #1
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| First
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| Phone Number
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| Personal Reference #2
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| Prefix
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| First
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| Phone Number
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Household Information
Please give us information about your home, yard and who lives with you.
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| Do you live in a;
| House Mobile Home Apartment Condo
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| Do you;
| Own Rent Live with family/friends
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| If you rent or live with others are you allowed to have pets?
| Yes No
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| If you rent or live with others please give the landlords name
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| Prefix
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| First
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| Landlords phone
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| Length of time at current residence?
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| If you have lived at your current address for less than one year please provide your previous address.
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| How long did you live there?
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| If you plan to adopt a dog, do you have a fenced yard?
| Yes No
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| What type of fence? i.e. chain link, stockade, etc.?
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| If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties?
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| How many adults live in your home?
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| How many children?
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| What are the ages of the children?
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| Do you have a swimming pool?
| Yes No
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| Have allergies to animals been a problem to any household member?
| Yes No
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| Aere all family members aware that you are considering adopting a pet?
| Yes No
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| Do they all approve?
| Yes No
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| Will you allow a home visit prier to adopting your new pet?
| Yes No
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Pet History
Tell us about your other pets.
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| Do you have other pets?
| Yes No
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| How many?
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| Are your pets current on their vaccinations?
| Yes No
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| Are your dogs on heartworm preventative?
| Yes No
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| Do your cats go outdoors?
| Yes No Sometimes They Live Outdoors
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Tell us about animal #1;
name, age type/breed, male/female, how long you have had this pet and where did you get it.
If this pet spay/neutered?
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Tell us about animal #2;
name, age type/breed, male/female, how long you have had this pet and where did you get it.
If this pet spay/neutered?
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Tell us about animal #3;
name, age type/breed, male/female, how long you have had this pet and where did you get it.
If this pet spay/neutered?
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| Have you had other pets in the last 5 years?
| Yes No
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| Tell us what happened to them.
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| Have you ever given up a pet for adoption?
| Yes No
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| If yes, please explain the circumstances.
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| Will there be someone home with your pet during the day?
| Yes No
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| What is the greatest number of hours the pet will spend alone daily/nightly?
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| Where will the pet spend most of its time?
| Crate Indoors Outdoors Garage Basement In a Run
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| Where will your new pets main sleeping quarters be?
| Crate Pet Bed Share a Bed with Owner Designated Room Outdoors Garage Basement
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| Will there be someone home at night?
| Yes No
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| Do you plan to travel with your pet?
| Yes No
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| If you can't take him, where will the pet stay while you are away?
| Friend or Family Kenneled In Home Pet-Sitting
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| Have you ever taken a dog to opedience class?
| Yes No
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| What types of activities do you plan for you and your pet?
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Desired Animal
Tell us about your vision of the perfect pet.
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| What type of pet are you looking for?
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| Gender
| Male Female No preference
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| What Age
| Baby Young Adult Senior
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| Would you accept an animal that has a treatable medical condition?
| Yes No Maybe
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| Why do you wish to adipt this type of animal?
| Personal Protection Companion Breeding As a Gift for Someone
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| If you adopt a cat are you planning to declaw him?
| Yes No
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| Are you planning to let the cat go outdoors?
| Yes No
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| Would you allow a U-CP representative to do a home check?
| Yes No
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Veterinarian Information
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| Name of current veterinarian
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| Prefix
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| First
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| Suffix
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Veterinarians Phone Number
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| How much do you think this pet will cost you each year(please include food, heartworm preventative, flea control, medical and dental care, supplies, training, grooming, boarding and toys)?
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Post Adoption Requirements
1. If you adopt a puppy or kitten, you are required to sterilize him/her by six months old.
2. If adopting a cat you will keep him/her indoors.
3. If adopting a dog you will abide by your town's leash law.
4. If adopting a dog you will continue to keep him/her on heartworm preventative.
5. You will return the pet to us if you feel you cannot keep him/her.
6. You must not sell the pet or give it to anyone else.
7. You are responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times for you companion animal.
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I certify that the information given on this application is true and correct. If I am approved by Up-Cycled Pets to adopt an animal, I agree to all of the above requirements. I understand failure to comply with any of the requirements will result in confiscation of the adopted animal.
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By submitting this application, the applicant states that all information is true and accurate.
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Image Verification
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EMF Survey