UNleashed Animal Rescue
Po Box 56
South English, IA 52335
*Animal Adoption Application*
As all of us know, when we adopt a pet(s). We do it with the best of intentions, planning to exceed our pet’s needs with the love and proper care for it’s lifetime. Adopting a pet should not be an impulsive decision. As it is a commitment, a life and should be a well thought out decision. One must understand the responsibility, and commitment that will come with pet ownership. The commitment to the life and well-being of your new pet for his or his entire life. Which could be 10+ years or more. UNleashed, will incur considerable expense and risk when the adopted pet leaves their possession. An while UNleashed does NOT loan out ANY pet’s. We do understand that sometimes the adopter may decide they have made a mistake in adopting a pet. Should this decision in his or her lifetime of the adopted animal arise. You agree the pet goes back to UNleashed animal shelter, unless otherwise authorized by an UNleashed Representative or his or her designate. As it takes some time for all pet’s to adjust to their new environment. You will be given 30 days giving the animal the adjustment time from adoption to get your full refund, otherwise UNleashed may incur considerable expense on the health and well-being upon the return of pet, after the return unto UNleashed possession, and therefore “NO” refund will be remanded after this said 30 day grace period. UNleashed’s goal and responsibility is to see that no pet becomes homeless, a burden or for any animal to suffer, this is essential. Please take your time and understand this application. Please Ask questions as they are always welcomed.
The UNleashed animal rescue & shelter has assumed responsibility for the welfare and well-being of every animal that enters its care. Our purpose is to place an animal in a responsible home for the rest of it’s life. This must be a home where it will receive Veterinary Care, proper housing and the necessary Essentials when needed. We will not adopt out if the animal is to become a free-roaming animal, our aim is to not add to the surplus of animals already homeless. To ensure these ends, we have formulated this application form to assist our staff in the careful selection of Home placements for our companion animals who are available for adoption. ONLY those who are adults of legal age will be eligible to adopt from our rescue. When UNleashed makes adoption decisions, we base it on what’s best for our animals. Our intent is to never offend any potential adopters. With that in mind, if you rent your residence. We will need to verify with your landlord that pets are allowed. Too many times pet’s end up back out on the street if a adoption is done without permission. We need to ensure our fur babies are going to “furever” home’s. We ask for your understanding.. In this application you will be asked questions pertaining to cat’s & dog’s. Please simply mark all that apply to you, skipping the questions that do not. ONLY answer the questions for the animal you are looking to adopt. Thanks for choosing to adopt. Because when you do. You save lives. Please answer all questions pertaining to you with honesty integrity.
We reserve the right to refuse any adoption for any reason
*Email will be a method of communication from UNleashed please check often*
Animal you wish to adopt :
• Cat
• Dog
Description: ______________________________________________
Pet’s name __________________
Potential adopters information:
Adopters name: _______________________
Date:____________
Street Address _______________
City_____________ State ______
Zip________
Number easiest reached ______________________
Cell phone number_____________
Email/Gmail _____________________________
Are you 18 years or older? _____
Date of birth _________________
Driver’s license number ________
State of Issuance __________
Do you live in a:
House ___ Apartment ___
Condo___ Dorm Room___
Mobile Home ___ Farm___
If other please specify_______
Do you:
Rent____ Own____ Sublet ____
How long at current address?____________________________
Landlords information:
Name: __________________________
Landlord’s phone ________________________
I own my own home and am a permanent resident. I am permitted to bring an animal or animals into my dwelling. _______________________ (Owner signature)
Please provide the following information about your household:
Number of adults______________
Number of children____________
Ages of children_______________
Are you aware that problems interacting with children is the leading cause of euthanasia amongst animals? Yes/No
Are you aware that is often because of the lack of limitations and boundaries on the child’s behalf, as animal’s have no voice to defend themselves? Yes/No
Which member of your family or household will hold primary responsibility for the welfare and well-being of your new pet? ____________________________
What is your reason for adopting a pet? ______________________
Please list information pertaining to the pets you currently own:
• Breed/type?______________
• Kept where?_______________
• Age? ________
• Sex of pet? ________
• Altered(spayed or neutered)? Yes/No
• Years of ownership? ________
Who is your primary veterinarian or past veterinarian? ____________________________
When was your animal(s) last visit to the veterinarian?____________________________
Reason?_____________________
Are you aware that in the first year regular preventative medical attention may cost $150 for an adult dog and anywhere from $100 for a cat? Yes/No
Are you aware that a dog or a cat can live 15 to 20 years and that they are a lifetime commitment? Yes/No
Do you or any members of your household have pet allergies? Yes/No
If so, who and what type(s) of allergies?__________________
Where do you plan to keep your pet full time? _______________
Questions pertaining to dog adoption
Does your yard have a fence? Yes/No
The adopted animal will be without human companionship for about _____ hours per day.
Where will this animal be kept when no one is home? ___________________________
Are you aware most dogs require daily exercise? Yes/No
How will you exercise your dog?____________________________
Do you understand the dogs are pack members who will develop bad behaviors without the proper leadership and proper companionship? Yes/No
Please describe your idea of Leadership:______________________________________________
Are you aware that most dog breed’s, where breed to have jobs and most are working dogs. Each having their own ability and skill such as hunting guarding herding Etc.. and that most will have an extreme drive to do such job? Yes/No
Do you understand that state laws and local ordinances require leashing, licensing, registration and vaccinations of a animal? Yes/No
Do you agree to this? Yes/No
Questions pertaining to both cats and dogs:
Do you understand the pet population is a serious problem? Yes/No
Have you ever been refused adoption from this or any other shelter in the past? Yes/No
If yes please explain ______________________________________________________________
Please tell us how you heard of UNleashed?___________________________________________
Please tell us why you would want to adopt from UNleashed?_______________________________________________________________________
Do you have any type of history of any type of abuse? Yes/No
If yes, please explain in full detail: ______________________________________________________
UNleashed has had a veterinarian perform initial medical examinations and have provided each animal with a necessary basic vaccinations. I understand that UNleashed provides no guarantee as to the health of my animal. And that my animal may have significant medical needs, socialization problems any may not be housebroken? Yes/No
How will you address these issues if one does arise?______________________________________________________________________________
In addition, for the safety of all our pack members, we will require ‘meet & greets’ for the necessary adoption evaluation.
Do you agree to meet and greets? Yes/No
It may take your animal two weeks, or longer, to adjust to its new environment.
Are you prepared to allow this much time for adjustment? Yes/No
Are you aware that cats should spend their first night in a small room with their food, water, and litter box as it will help them better adjust? Yes/No
Are you willing to do this? Yes/No
Our goal is to match you with the best possible pet for you. Unless you specify a certain breed or animal, UNleashed will try its best to match you with the animal that best fits your lifestyle.
What do you or your family do as a hobby or activity?_____________________________________
__________________________________________________________________________________
Do you have any of the following ‘pet peeves?’
Chewing on things?______
Pets being on furniture?______
Pets being on counters?_______
Scratching furniture?_______
Barking?______
Digging?______
Potty problems?_______
Waking you up?_______
Other please explain: ______________________________________________________________
How will you introduce your pet to their new home?___________________________________________________________________________
List of three references (people who know you but are not related to you or not in a relationship with you or in your current household)
*Name: ___________ is my ___________(relationship to you) years known ___________
Phone Number: __________ best time to call _____________ am/pm
*Name:__________ is my ___________ (relationship to you) years known ____________
Phone Number: __________ best time to call _____________ am/pm
*Name:____________ is my ________ (relationship to you) years known_____________
Phone Number: ___________ best time to call ___________ am/pm
Please understand there are specific policies on holding animals
I understand I am being given the opportunity to become a pet owner through UNleashed animal rescue. I understand that I will be required to care for the welfare and well-being of the animal(s) I wish to adopt. I have read and fully understand this adoption application, in its entirety. I agree that all statements and stated agreements contained in this application are made by me, and are truthful under the penalty and prejury under the law(s) of the state of Iowa. By signing below, I certify that all information I have given is true and that I recognized that any mistreatment of the application form will result in my losing the privilege of adopting, or keeping an adopted animal. And, that I authorize investigation of all statements in this application. I understand that this application is the property of UNleashed animal rescue.
I,___________________ (name of applicant) make the following statements voluntarily, to provide the necessary substance, care and security to the safety of the animal(s) I wish to adopt from UNleashed.
Today’s date: ___________________
Applicants signature: __________________________________
Applicants printed signature: __________________________________________
UNleashed Animal Rescue 