Adoption Application PPR
Email address *
Adoption Applicant Full Name *
Do you have a specific dog you are applying for? *
If YES, specify name or type NO.
If that dog is no longer available do you want to continue with the approval process?
Clear selection
Are you working with any other rescue organizations?
Clear selection
Your Date of Birth *
Street *
Town *
State *
Zip Code *
How long have you been at this address? *
Are you planning to move soon? If yes, where are you moving? *
Phone Number
Cell Phone
Do you own or rent? *
Renters MUST provide landlord's Name, Phone, and eMail.
Personal Reference #1 Name *
Cannot be a relative or household member.
Personal Reference #1 Phone *
Personal Reference #1 eMail *
Personal Reference #2 Name *
Cannot be a relative or household member.
Personal Reference #2 Phone *
Personal Reference #2 eMail *
List all human members of your family (including yourself) *
Must include names and ages
Does anyone in the household have allergies to pets?
Clear selection
List all animals in your household *
Include Species (dog, cat, hamster, etc), Gender, Age
Are all of your pets fixed (sterilized)? *
If no, explain.
Are all pets current on their shots? *
Are all dogs current on their heartworm preventative? *
Are all dogs current on their flea/tick preventative? *
Do you have livestock or chickens? *
Do you have a fenced in yard? *
If yes, describe type and height
How many hours per day will your dog be alone on a daily basis?
If you currently have NO pet, have you ever owned one prior? If yes, did you surrender or euthanize? Please explain. *
Veterinary Reference: *
MUST include name of veterinary clinic and address
Vet's Phone Number *
May we contact your vet? *
If yes, I will authorize my vet to share my pet(s) medical records with PPR.
Additional Comments
I understand and agree that Passion For Pets Rescue (PPR) has made every effort to provide an accurate history and assessment of the dog(s). PPR is not able to guarantee any dogs’ age, breed, medical status or history, behavior or disposition. I hereby release PPR and its volunteers, directors, members and representation of any and all possible claims arising from injury or damage caused by any dog(s) adopted by me to any person or property or relating to the health or temperament of the dog(s), including any expenses related hereto. *
I understand and agree that my rescue dog(s) comes into contact with many animals and environments before being adopted. They may be exposed to any number of common illnesses or parasites due to overcrowding, stress, environmental changes and transport. PPR has begun proper care for these dogs/puppies, however, sometimes illness can and may lay dormant with NO visible or detectable signs for up to several weeks after arrival. *
I understand and agree that a fecal test on an adopted dog/puppy can show negative results, however, worms/parasites may appear after arrival. Fecal tests can detect parasites but the dog/puppy must have parasites passing/shedding of eggs or segments to test fully positive. *
I understand that I am responsible for all costs associated with pet ownership, which includes preventative medication and veterinary care. I agree to return the dog(s) to PPR if I can no longer keep this dog. PPR will not refund the adoption fee, if the dog is returned after two weeks. *
I agree to the PPR Adoption Terms and Conditions. I have read, in full, and understand the PPR Adoption Guidelines set forth by Passion For Pets Rescue. By entering my name in the signature box below, I attest that the information provided herein is accurate. I am granting permission for vet checks on current and past pets, as well as personal reference checks. I understand that scheduling of a home visit is part of the adoption application process. I understand that if falsified information is discovered, my application will be denied. *
I would like to donate to the Passion for Pets Rescue emergency medical fund. *
Yes or No
How did you come to apply to Passion for Pets Rescue? *
Please check only one box.
Signature *
Date *
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