Domino Effect Animal Rescue Adoption Application
Animal's name you are interested in
Address (Street, City, State)
Who is the animal for?
Will you be the primary caregiver?
Where do you live?
Does your home have a fenced yard?
Do you :
own your home
rent your home
If renting, does your lease allow pets?
May we call your landlord?
If no, please explain?
Landlord’s phone number
May we do a home check?
What activity level are you looking for in a pet?
Please check all that apply.
I’m looking for someone to go running/hiking with me
I want someone to relax and watch tv with me
I’m looking for a service animal
I’m looking for a working/ranch animal
The animal will live primarily
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?
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?
If you have children, how old are they?
Do all members of the family know about and want this new animal?
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.
A copy of your responses will be emailed to the address you provided.
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