PLEASE NOTE: The information
on your application will be verified.
Any false information will result
in immediate denial of your application.
A.R.V.S.S.* ADOPTION FORM
*Animal Rescue & Veterinary Support Services
Name, Birthdate and Address
Phone Numbers - work, home, cell:
please star preferred number
Which dog/puppy are you interested in?
If your choices are no longer available, please let us know what you are looking for and we'll try to find a match for you (breed, sex, age, etc.):
Do you rent, own, live in a condo?
We verify home ownership or get approval from your landlord.
We do this because one of the top 10 reasons unwanted animals are surrendered is "landlord does not allow pets."
If you rent or live in a condo, please provide landlord's name/Condo Association contact and phone number:
Number of family members and/or roommates. Please list ages of children:
Please list other animals you have owned - and describe current pets:
Are your animals up to date on all vaccinations (rabies, bordatella, distemper)? If no, please explain:
Are your animals up to date on heart worm treatment? If no, please explain:
Are your animals spayed or neutered? If no, please explain:
Have you ever surrendered or re-homed an animal? If yes, please explain:
Vet's name and phone number (Please note we will call your vet to verify shot records and care):
3 personal references, include phone numbers (not family members or people in your home):
Where will the dog be kept? examples: in a fenced yard, in the house,
crated when alone, etc.:
Why do you want to adopt a dog/puppy?
Do you plan to take your dog to obedience class?
Are you familiar with the licensing requirements in your community?
Animals can be expensive to care for - Estimated annual average for one dog is $300-$400.00. Are you willing and able to proved adequate food, shelter and medical care, including yearly check-ups and vaccinations for an adopted dog? ARVSS is not responsible for extraordinary medical costs your pet may require.
Where did you hear about ARVSS?
A dog may live for 15-20 years and will need
your committed care for his or her lifetime!
By placing my initials or signing my name to this application, I certify that the information I have given is true. I realize the any misrepresentation of facts may result in my losing the privilege of adopting an animal from
. I understand that
has the right to deny my request to adopt an animal for any situation that would be contrary to the organization's adoption policies, in violation of any state or local ordinances, or not in the best interest of the animal, as determined by
. I authorize verification of all statements in this application, and I also authorize my veterinarian to release any information requested by