Adoption Pre-Interview
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Owning a pet is a serious responsibility. It is imperative that each person or family who adopts a pet must understand and accept the responsibility and commitment that pet ownership requires.
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| Name
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| Age
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| Email
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| Phone Number
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| Address
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| Occupation
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| Work Hours
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| Which animal are you applying for?
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| Have you had a pet before?
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| If yes, what types of pets have you had?
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| Do you still have them? If yes, please list age, sex, and breed.
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| If you no longer have a pet, please describe why.
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| Are your pets spayed or neutered?
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| Are your pets up to date on vaccinations?
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| Are your pets on heartworm prevention medicine?
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| Why do you want this animal? Please choose all that apply.
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Companion for you Companion for family member Companion for other pet Hunting Protection
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| Do all members of your household want a pet?
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| Who will be primarily responsible for this animal's care?
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| How many adults currently live in your home?
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| How may children currently live in your home?
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| What are their ages?
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| Does anyone in your family have pet allergies?
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| How many hours a day will this animal be left alone?
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| If you go on vacation, who will take care of this animal?
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| Where do you live?
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| If you rent, please provide your landord's name.
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| If you rent, please provide your landlord's phone number.
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| May we contact your landlord to obtain permission for this animal to live in your home?
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| Is your yard fenced?
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| If yes, what type of fence and how tall is it?
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| Do you plan to chain or tether this animal?
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| Do you agree to provide this animal with heartworm prevention medicine and veterinary care?
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| If this animal is unaltered, do you agree to have it spayed or neutered?
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| Where will you keep this animal during the day?
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| Where will you keep this animal at night?
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| If this animal is not housebroken, how do you plan to train it?
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| If this animal chews your furniture or personal belongings, what will you do?
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| If for any reason you cannot keep this animal, what will you do?
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| Have you ever had an animal die as the result of being hit by a car?
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| Name of Veterinarian
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| Location of Veterinarian (City, State)
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| Veterinarian's Phone Number
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| How did you hear about EMAR?
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| I understand that pet ownership is a commitment for life and bringing a pet into the family means he/she will be treated like a family member. I understand pets cost money and must take heartworm prevention monthly and see a vet yearly.
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Yes No
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| I understand that I will be sharing my life with a pet for many years, who is totally dependent on me for food, shelter, health, and veterinary care. I am willing to make this long-term commitment to this pet as a family member.
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Yes No
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EMAR has the right to refuse adoption to anyone for any reason.
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The information provided in this application is true and complete. Through my signature, I confirm that I agree to cooperate in the adoption process by providing medical care, training, and pet related amenities.
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Further, in the event that East Mississippi Animal Rescue places an animal in my household, I agree not to transfer that dog to any third party; but rather I will return the dog to EMAR in the event I can no longer retain it.
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| Signature
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EMF Online Form