First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Home Phone

Cell Phone*

This application is the first step in helping to determine if your household is prepared to assume the role and responsibility of a rescued animal. Please answer each question thoroughly. Failure to do so will result in your application being stalled. There is no way for you to edit your application once you submit it, so you may be asked to resubmit an entire application in the case of questionable or incomplete answers. Please read the Adoption Process on our website at cvrrescue.org and understand that we require a vet reference for each applicant. You will be asked to submit information that your current and/or former pets are up to date on vaccines, heartworm protection, and standard veterinary care. It is imperative that the information you provide is accurate and verifiable. By clicking Yes below, you agree that pet ownership is a serious commitment that the entire household needs to consider and agree before an animal is adopted, and you acknowledge that you and each member of the household are aware of and willing to accept the physical and financial responsibilities of pet ownership.*

Which animal are you interested in? (Please note that cats are listed first with an asterisk, followed by dogs.)*
Choose an animal: **Barn Cat** **Undecided - Cat** **Undecided - Dog Small Breed** **Undecided - Family Dog - Adult** **Undecided - Kitten** **Undecided On Specific Animal** *Aquafina *Bo *Brooks *Buddy *Clove *Coriander *Dumbledore *Furgison *Gryffin *Joseph *Kasey *London *Luke Skywalker *Olive *Sabrina *Samara *Silvia *Tigger *Tulip 101 Dalmatians Litter: Dipstick 101 Dalmatians Litter: Freckles 101 Dalmatians Litter: Patch 101 Dalmatians Litter: Penny 101 Dalmatians Litter: Pepper 101 Dalmatians Litter: Pongo 101 Dalmatians Litter: Willow Avery Beaumont Enzo Fluffy Hulk Indy Junior Lady Ladybug Luca Molly Moose Moseley Mouse Mr Houndy Smokey Sprout Sunny Togo Wrangler

In case someone from the rescue needs to contact you, do you prefer to be contacted by text, phone call, or email?

When is the best time to contact you?

What is your date of birth? *

Are you the owner of the home you live in? Please indicate whether you own or rent your home. Please note that we check public records for confirmation of ownership. If you, the applicant, are not the sole owner of your home, please provide below the name, address, and phone number of the owner/landlord so that we can verify that a pet is accepted. Failure to provide this information will automatically stall your application.*
Choose one: Rent Own

If you are renting please provide your landlord's name AND contact information (phone number or email address).

If renting, do you have your landlord's permission to have pets? Be prepared to provide a copy of the lease agreement or a written statement from the landlord.

Please list each person or family member in your household, stating for each their name, age, relationship to you, and whether they will be a primary caregiver for the pet.*

Describe your home's activity level:

Have there been any other pets in your home or otherwise owned by you? Please provide names, ages, genders, breeds, etc. for any current pets as well as any previous pets.*

For any current or past pets: Are they spayed/neutered and up to date on vaccines? If not, please explain why. Are dogs on heartworm prevention? If not, why not? Have cats been tested for FeLV/FIV?*

What is your place of employment and job title?*

What experience do you have with animals?*

Why are you interested in this particular pet at this time?*

What type of housing/habitat will you be able to provide for this pet?*

Will the animal be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Describe how long the pet will be unattended on a daily basis and where it will be kept during this time.*

How long do you think it will take this pet to acclimate to a new home environment? For example: 3 days, a week, a month?*

Please provide the name and phone number for the veterinarian(s) who have provided care for any current and previous pets. (Please note that failing to provide both name and contact info may result in your application stalling.)*

Have you ever given up or rehomed a pet? If yes, please explain.*

Please describe the personality traits of the kind of animal you are looking for:*

How did you find out about Central Virginia Regional Rescue?*