Adoption Application

You can submit an Adoption Application online using the form below, or you can download and print this application, fill it out and mail it to the address listed on the form.
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Your contact information
First Name:
Last Name:
Title: Ms.   Mrs.   Mr.   Dr.
Primary Phone:   Number is:  Home   Cell   Work
Other Phone:   Number is:  Home   Cell   Work
Street Address:
City:   State:     Zip: 
Email Address:
 
Adoption Questionnaire
Name of the animal you are interested in adopting:  
Why do you want to adopt a dog/cat?
Have you owned a dog/cat before:   Yes     No
What happened to your last pet?
Do you have a fenced yard?   Yes   No   If Yes, how tall? 
Where will this animal sleep? 
Which of the following currently live in your home?
(please check all that apply)     Dog(s)     Cat(s)     Child(ren)
How many hours each day will the animal be alone? 
How much are you able to spend on this pet annually? 
Who will care for the pet in your absence? 
Emergency Caregiver: Please provide the name and phone number of someone who would care for the pet if you could not, either permanently or for an extended period:
Emergency Caregiver Name:
Emergency Caregiver Phone:
Veterinarian Information (for current or past pet owners):
Your Veterinarian's Name:
Your Veterinarian's Phone:
Does everyone in the household want a pet at this time?   Yes    No
Are you willing to attend obedience class?   Yes    No
Do you own or rent your home?   Own    Rent
If you move, what will happen to the animal?
What reason(s) might cause you to give up a pet?
Please list the name, age and sex of each person living in your household:
Name Age   Sex
       Male     Female
 Male     Female
 Male     Female
 Male     Female
List any additional household members below

Meet the Animals

See our Petfinder list of adoptable animals

Contact us
Special Pets Rescue
P.O. Box 1247
Lower Lake, CA 95457
Phone: (707) 350-7008 or (707)994-0123

Email: info@specialpetsrescue.org