www.chewy.com/rp/9139
PLEASE HIGHLIGHT AND COPY THE AREA BETWEEN THE STARS, PASTE INTO EMAIL ADDRESSED TO CCPRNOKILL@AOL.COM, FILL IN ALL THE BLANKS AND SELECT SEND
**********************************************************************************
CORYELL CO. PETS RESQ *C.C.P.R.* NO KILL. APPLICATION FOR PET ADOPTION
www.facebook.com/ccprnokill (254) 248-5002 Return via email to ccprnokill@aol.com
MUST BE 18 YEARS OF AGE OR OLDER. FILLING OUT THIS APPLICATION DOES NOT GUARANTEE YOUR APPROVAL TO ADOPT THIS PET. PLEASE PRINT
Name of animal you are applying for: ________________________________________ Date:___________________________________
YOUR E-Mail Address. ________________________________________________________
Please answer each question COMPLETELY & HONESTLY. If any information is left blank, we may NOT be able to process your application. COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE ADOPTION OF A PET FROM CCPRNOKILL. This application does not “hold” the pet you are applying for.
Full Legal Name: ________________________________________________D.O.B:_______/_______/_______
Address: _________________________________________________Unit/Apt/Lot#___________
City _____________________________________________________State ______________ Zip______________________
Home Phone: _______________________ Cell Phone ______________________________
Type of residence: (CHECK ONE) House _____ Mobile home _____ Apartment _____ Travel trailer_____/ Rent _____ Own____
Do you have a fenced yard? __________Type of fence? ________________________
LIST 2 PERSONAL REFERENCES:
Name: ____________________________Phone: ______________________________________
Name: ____________________________Phone: ______________________________________
Are You: Student ___ Employed___ Retired ___ Disabled ___ Between Jobs ___
Number of adults in home? ______. Number of Children in home? ______.Ages of children: ___________________________
*Are you willing to let a representative of CCPRNOKILL visit your home? Yes________ No________
Are you able to responsibly and financially support this pet? Yes ______ No _____Not Sure ________
Have you ever had to re-home a pet because you were moving?_____________
Have you ever had to give up a pet? Yes ____ No____. If so, why: ________________________
**Please list all of your current or most recent pets’ names, ages, gender, breed, reproductive status: (use separate sheet if necessary) _________________________________________________________________________
*NOTICE* Please list the VET used for your current or most recent pet for REFERENCE.
Name of Practice: _____________________ Phone #:________________________________ Release for veterinarian reference: I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my pets to Coryell Co. Pet ResQ *CCPRNOKILL, including the pet I’m adopting at this time for follow-up purposes in the case of existing conditions or simply well check & heart-worm prevention status.
Sign: ________________________________________Date:___________________________ By signing or typing your name you are stating all of the above information is true & correct to
the best of your knowledge and that you have read and understand this application. The electronic form of signature will be treated the same as your original signature.
**************************************************************************
THE ONLY WAY TO HOLD A PET IS TO PAY THE NON-REFUNDABLE ADOPTION FEE UP FRONT. SIMPLY FILLING OUT AND SUBMITTING YOUR APPLICATION DOES NOT MEAN THAT WE WILL HOLD THE PET FOR YOU. APPLICATIONS ARE OFTEN PROCESSED WITHIN 15 MINUTES (ON WEEKDAYS) IF WE CAN REACH YOUR VETERINARIAN AND PERSONAL REFFERENCES. SOME VET CLINICKS REQUIRE YOU TO CALL AND RELEASE THE INFORMATION.