www.chewy.com/rp/9139
www.chewy.com/rp/9139
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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.
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 WILL NOT be able to process your application.
Full Legal Name: ____D.O.B:_______/_______/_______
Address: ___ City______State _________ Zip________
Primary Phone: _______________________ Secondary Phone ______________________________
ID or DL #________________________________________ State _______ Exp. _______________________
Type of residence: (CHECK ONE) House _____ Mobile home _____ Apartment _____ Travel trailer_____/
Military Base Housing _____/ Live with Parents _____
*DO YOU Rent _____ Own____
RENTAL AGENT/LANDLORD CONTACT INFO ________________
Do you have a fenced yard? __________Type of fence? (i.e. -Chain link, barbed wire, cattle panel, chicken wire, privacy, etc.) ________________________.
No fence - Plan to cable or chain when outdoors for safety of pet. YES_____NO_____
LIST 2 PERSONAL REFERENCES:Can not be living with or related to you:
Name: ________________Phone: __________Association_______Know How Long______
Name: ________________ Phone: _________Association _______Know How Long______
Are You: Student __ Employed__ Retired __ Disabled __ Between Jobs __ Military Enlisted __ Spouse of Military Enlisted __Pre-Enlistment__Students living independent of parents__Student living with parents__Other__
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?_____________
* Do you believe in or practice the use of heartworm prevention? Yes_____ No______
*Do you believe in the practice of neutering male pets to prevent unwanted litters? YES___NO___
*Have you ever had to give up a pet? Yes ____ No____.
If so, why: _______________
*What would you do with this pet if you lost your source of income? ________________________________________________________
**Please list all of your current or most recent pets’ names, ages, gender, breed, reproductive status: ___________________________________________________________________________________________________________
*NOTICE*NOTICE*NOTICE* Please list the VETERINARIAN used for your current or most recent pet for REFERENCE. *** YOU MUST HAVE A VET REFERENCE!
Practice: ______________________________________________________
Phone #:___________________________________________
((((((VETERINARY RECORDS MUST BE IN YOUR NAME, NOT YOUR PARENTS NAME. PLEASE DO NOT LIST A VET YOU INTEND TO USE...THIS MUST BE A VETERINARIAN YOU HAVE ALREADY USED AND HAVE HISTORY WITH.))))))
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 *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. (The pet then boards for $5.00 per day at our facility until you come to pick them up and take them to their forever home.) CCPR DOES NOT FLY PETS AS FREIGHT. ALL TRANSPORTATION & TRANSPORT CERTIFICATION FEES ARE PAID FOR BY THE ADOPTER. **APPLICATIONS ARE OFTEN PROCESSED WITHIN 15 MINUTES (ON WEEKDAYS) IF WE CAN REACH YOUR VETERINARIAN AND PERSONAL REFERENCES. SOME VET CLINICS REQUIRE YOU TO CALL AND RELEASE THE INFORMATION. CCPR Should not have to ask you to contact your veterinarian to release information. Please contact your veterinarian to save time.
**If your application is denied - The Fee to "hold" the pet is non-refundable and you will receive a receipt of your donation to the rescue.