Chesed Rescue Adoption Form

Chesed Rescue

If you wish to complete this by mail or fax, please click here for a PDF adoption form

Adoption Form

Note: Chesed reserves the right to refuse an application.

Name
Occupation
Address
City
State	Zip
Day Phone
Night Phone
Cell Phone
Fax
Email
Name of your spouse or significant other (if applicable)
His/Her Occupation
Any other adults in the home?	Yes No
If yes, what is their relationship to you?
Which pet are you applying for?
Why are you interested in adopting this pet?
Do you have children?
If yes, how many and what ages
Do you have other pets?
If yes, how many?
Where did you get them?
How long have they been in the home?
Please list name/breed/age
Are all of your current pets spayed and neutered?	Yes No
May we contact your Vet?	Yes No
If yes, please provide Vet’s Name
Vet's Phone
How long have you been using this vet?
If you currently have no pets, did you have pets in the past?	Yes No
If yes, how did they die or why are they no longer with you?
How long have you lived at your current residence?
Do you live in a house, townhouse, apartment or trailer?
How long in your current residence?	Rent Own
If you rent, do you have a letter from your landlord allowing you to have pets	Yes No
A letter and contact phone number will be needed to review application.
Are you familiar with your homeowners’ association rules on pet ownership?	Yes No Not Applicable
Do you have any pet restrictions?	Yes No
If yes, what are they?
Do you have a backyard?	Yes No
If yes, is it fenced?	Yes No
If yes, how tall is the fence and of what material?
Do you have a swimming pool?	Yes No Is it Fenced or Gated? Yes No
How will exercise and potty breaks be handled?
Who will be responsible for the pet you wish to adopt?
Would this pet be an inside, outside or an in/out pet?	indoors outdoors both
Where will this pet sleep at night?
Where will this pet stay during the day?
How many days per week do you work?
How many hours per day?
How many hours a day will this pet be alone?
Who will be responsible for this pet while you are away (vacation, emergencies, etc.)?
Are you willing to submit to a home check before and after you adopt?	Yes No
If no, why?
How long do you plan on keeping this pet?
Are you prepared to spend extra time and training in the beginning?
How much one-on-one time will you have for this pet every day?
How long have you been looking for a new pet?
Has everyone in your home agreed on this pet?	Yes No
If no, whom and why ?
Under what circumstances would you return this pet (moving, financial difficulties, vet bills, new baby, pet’s behavior, etc..)?
If you should no longer want this pet what would you do?
Is anyone in your home allergic to animals or suffer from allergies?

Are you planning on moving anytime soon?
If yes, where and why?
Are you aware of the spay/neutering requirements if it hasn’t been done already?
Are you willing to pay the surgery?	Yes No
Are you familiar with an animal trainer or obedience classes in your area?	Yes No
Are you willing to get professional training for your pet?	Yes No
If no, why?
How would you discipline this pet? .
Are you at least 21 years of age and capable of entering into a legally binding contract?	Yes No
Are you financially capable of providing the necessary veterinary care, emergency veterinary care, shelter and food for this pet?	Yes No
Have you made arrangements for your pet in the event of your death or inability to provide proper care?	Yes No
If no, why?
IF FOR ANY REASON YOU CAN NO LONGER KEEP THIS PET, DO YOU AGREE TO RETURN TO CHESED FOUNDATION INC?
Please read and certify the following: By submitting this form I certify that all information in this application is true, and I understand that false information may void this application. I agree that upon adopting a pet from Chesed Foundation, Inc. I will agree and abide by their Adoption Agreement. By typing my name here I am indicating I have read the paragraph above: Date:
Please use this space below for any questions, comments or concerns you may have