Personal Information
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Name:
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Address:
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City:
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State:
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Zip:
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Home Phone:
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Cell Phone:
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Email Address:
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Date of Birth:
SSBBR Animals You Are Interested In
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Please list the SSBBR animal(s) you are interested in:
Household Information
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Do you:
Own
Rent
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Do you live in a:
House
Apartment
Trailor
Duplex
Other
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Do you live with:
Alone
Spouse/Partner
Spouse/Partner & children
Children
Roommate(s)
Parents
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Please list the names, ages, and genders of all people who would be living with the pet:
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Is this pet for you or is it a gift for someone else?
For Me
A Gift
If it is a gift for someone, please describe:
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Do you have a fenced yard?
Yes
No
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Describe your fence height (wood, chain link, etc) and height:
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If you do not have a fence, please describe how you will exercise your pet and handle bathroom needs:
If you rent, please complete the following:
Landlord/Management Company Name:
Landlord/Management Company Phone Number:
Animal Experience
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Please list the breed, age & sex for all animals who would be living with the pet:
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Are all the animals listed above spayed or neutered?
Yes
No
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If they are not spayed or neutered, please tell us why:
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Are all the animals listed above current on vaccines, heartworm prevention, & flea/tick prevention?
Yes
No
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If they are not vaccinated, on heartworm prevention, or on flea/tick prevention, please tell us why:
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Please list any pets you no longer own and the reason you no longer own them:
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Please list the name and phone number of your current veterinarian:
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Where would the animal be kept when you are not at home:
Outside loose
Outside on a chain
Outside in a pen
Inside loose
Inside in a kennel
Inside confined to a specific area
At pet daycare/boarding facility
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Where would the animal be kept when you were at home?
Outside loose
Outside on a chain
Outside in a pen
Inside loose
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For what reason(s) do you want an SSBBR pet?
Companion for family
Companion for other pets
Protection
To Breed
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Please list any behaviors you CAN NOT handle in an animal:
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Are you prepared to make a 10-15 year commitment to a pet:
Yes
No
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Rescue pets may take a few months to adjust to a new environment. This may include chewing, marking, trying to escape from the yard. Please tell us how you have prepared for this. (ex. - go to training with pet, "pet proof" home, etc...)
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Please list all the things you think a pet needs, just to provide BASIC healthcare:
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How much do you think owning and properly caring for a pet costs each year?
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Do you agree that this form is an application, NOT A GUARANTEE, to adopt a pet from SSBBR
I Agree
I Disagree
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Do you agree that all the information you provided on this form is true, and if any information is proved false, you forfit any right to ever adopt an animal from SSBBR?
I Agree
I Disagree
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