APPLICATION TO ADOPT

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

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CORYELL COUNTY PET RESCUE - NO KILL *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.

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:

Can not be living with or related to you: 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. *** YOU MUST HAVE A VET 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 County Pet Rescue - No Kill *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.

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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.