Almost Home Animal Rescue of Rutherford County

Middle Tennessee's Premier Large-Breed Dog and Horse Rescue

Almost Home Animal Rescue

Adoption Application

*-indicates a required field

Applicant's Information
First Name:*	Last Name:*
Address:*
City:*	State:*	Zip:*
Home Phone:*	Cell Phone:
Driver's Lic#:*	Email Address:*
Age:*

Adoption Information
Adopting Pet's Name:
Pet Type:
Breed:
Sex:

Adoption Questionaire (Please Answer ALL questions)*
Why do you want to adopt a pet?


Is this your first experience with this type of pet?
YES	NO

What pets do you currently have in your household?
Name?	Sex?	Breed?	Spayed/Neutered?		Kept In or Out?
			YES	NO	Inside	Outside
			YES	NO	Inside	Outside
			YES	NO	Inside	Outside
			YES	NO	Inside	Outside

List pets owned in the past 5 years, other than those listed above.
Name?	Sex?	Breed?	Where is this pet now?





Your Veterinarian's Clinic:			Phone:

Will you allow above named clinic to release information regarding all current and former pets to Almost Home?
YES	NO

You currently live in a:
House:
Apartment:
Condo:
Mobile Home:
Duplex/other:

Do you own a swimming pool? Yes No

Do you Rent or Own?
Rent:
Own:
Live with Parents
If you rent, does your landlord allow pets?
YES	NO

Landlord's Name:		Landlord's Phone Number:

How large is your household,including yourself?
Adults:
Children:

What are the ages of the children in the household?

Does anyone living in your household have any known allergies to animals?
YES	NO

Who will be responsible for the care of the pet you want to adopt?


Where will this pet be kept during:
the Daytime?
the Nightime?

Where will this pet be kept when alone?


Approximately how many hours per day will this pet be alone?

Do plan on spaying or neutering the pet you want to adopt?
YES	NO

How did you hear about our adoption services?


Dog Adoptions Only
Do you want the dog for a (check all that apply):
House Pet:
Guard Dog:
Watch Dog:
Companion:
Gift:
Company for other pet:
Other:

Do you have a fence?
YES	NO
If yes, how high?
Fence Type:
If "other" please explain:

Do you realize you will most likely have to house-train your new puppy or dog?
YES	NO

Would you like information on how to house-train a new puppy or dog?
YES	NO

Are you familiar with the leash and licensing laws in your community?
YES	NO

What will you do if your dog chews furniture or shows signs of other destructive behavior?


Are you familiar with heartworm disease?
YES	NO

How will you keep your dog confined to your property (check all that apply)?
House:
Kennel:
Fenced Yard:
Chain:
Garage:
Patio:
Runner:
Underground Fence:

By clicking the "Let's Adopt" button and checking the box below, you attest that the answers provided in this application are true. If any of these answers are discovered to be untrue, Almost Home may enter your property and take possession of the animal. You are also agreeing to the following terms:
I agree I will have the pet spayed/neutered within 30 days after the dog reaches the age of six months. I agree to provide proper food, water, adequate shelter, and kind treatment at all times. I agree to take the dog to a veterinarian for examinations and immunizations as needed and if the dog should become ill or injured, I will provide care at my own expense. I agree to notify Almost Home if I decide at any time I can no longer keep or provide proper care for the dog listed above. I further agree that if I decide I can no longer care for the dog, I will return the dog directly to the care of Almost Home in Rutherford County, TN at my own time and expense. I agree I will not use the dog for hunting purposes. I agree I will not chain or tie the dog in any fashion at any time. I agree that an Almost Home representative can make an unscheduled visit after the adoption to ensure the dog's well being. If it is deemed the dog is not being well cared for, Almost Home may enter my property and may take possession of the animal. I agree that Almost Home cannot guarantee the health, temperament, or training of the dog listed above, and agree to release Almost Home from all liability once the animal is in my possession. I have read these statements and understand the rights and obligations involved. By signing below, I attest that the answers I provide in this application are true. I further agree that if any of these answers are discovered to be untrue, Almost Home may enter my property and may take possession of the animal.

By checking here, you agree to, and are legally bound by all the terms and conditions listed above.