Domino Effect Animal Rescue Adoption Application
Email address *
Adopter’s Name
Adopter’s Occupation
Animal's name you are interested in
Address (Street, City, State)
Home Phone
Cell Phone
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 yard?
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Do you :
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If renting, does your lease allow pets?
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May we call your landlord?
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If no, please explain?
Landlord’s phone number
May we do a home check?
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What activity level are you looking for in a pet?
Please check all that apply.
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 during the day?
Where will the animal be left when alone?
Do you have other pets at home?
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If yes, list breed, sex, age
If you have no other pets at home, have you had pets before? If yes, what happened to them?
Do you have children?
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If you have children, how old are they?
Do all members of the family 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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