Domino Effect Animal Rescue Adoption Application

Thank you for choosing to adopt! This application is used to assess potential homes for our animals. Please fill out the form honestly. Your home may be perfect for some pets but not be the right match for this specific animal. Please keep in mind that every animal is different. We want to make sure each of our rescues integrate well with their next family so that you and they can live happily together! ❤
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Email *
 Adopter’s Name
Adopter’s Occupation
Animal's name you are interested in
Address (Street, City, State)
Home Phone
Cell Phone
Facebook or Instagram handle:
Who is the animal for?
Will you be the primary caregiver?
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Where do you live?
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Does your home have a fenced yard?
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If yes, what kind of fence?
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How tall is the fence?
Do you:
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If renting, does your lease allow pets?
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May we contact your landlord?
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If we cannot contact your landlord, please explain why.
Landlord’s contact information:
May we do a home check?
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Where would your pet go if you moved?
The animal will live primarily
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Where will the animal sleep?
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How many hours will the animal be alone (without human supervision) during the day?
Where will the animal be left when alone?
Do you have other pets at home?
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If you have other pets, please list breed, sex, age, and if they are spayed or neutered.
If you have no other pets at home, have you had pets before?
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What are you looking for in your pet/what activities do you plan to do with your animal?
Please check all that apply.
Have you ever trained or gone to obedience classes with a pet?
Have you ever had to euthanize a pet? If yes, why?
Have you ever had to rehome a pet?
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If yes, why did you rehome the pet?
Do you have a regular vet? If yes, who/where?
What is your budget for routine vet care? Please specify if the amount is monthly, annually, or per visit.
What is your budget for emergency vet care? 
Do you have someone or somewhere that can care for your pet, should you become physically incapable? (Car Accident, Hospitalization, Illness, Injury, or Death)
Do you have any children living with you?
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If you have children in the house, how old are they?
Do all members of the household know about and want this new animal?
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If no to the previous question, please explain.
Is there anything else you would like to share with us?
I certify that, to the best of my knowledge, the information provided in this application is true and complete.  I realize that any misrepresentation of that information will result in my losing the privilege to adopt from Domino Effect Animal Rescue. I also understand that this application does not guarantee that I will receive this animal.
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A copy of your responses will be emailed to the address you provided.
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