Autumn Acres Animal Rescue - Adoption App
Interested in adopting one of our dogs? Please fill out this form.
Email address *
Name of the animal you are interested in?
Your answer
Your name (First and Last):
Your answer
Your street address:
Your answer
City, State, Zip Code:
Your answer
Home Phone:
Your answer
Cell phone:
Your answer
Household Pet Information
Do you have any pets now?
If you have pets now how many and what kind(please describe them). If you don't have pets now please list pets you've had in the past.
Your answer
How long have you had them?
Your answer
How old are they?
Your answer
Would you consider them indoors mostly or outdoors mostly?
Your answer
What veterinary clinic do you use for your animals?
Your answer
What name would the file be under at that clinic?
Your answer
Where do your pets spend most of their time?
Your answer
Where do they usually sleep?
Your answer
How many children are living in your home and how old are they?
Your answer
How many hours is the family away from the house?
Your answer
Where will your new pet sleep?
Your answer
Where will your new pet stay when no one is home?
Your answer
How long have you lived at your current residence?
Your answer
Note: We do NOT require fenced yards. This question just lets us know if we need to warn you about a fence jumping dog. Is your yard fenced? Please describe your yard:
Your answer
Do you rent or own?
How long at your last residence, did you have pets at the last home, if so where are they now?
Your answer
Any other information you wish to let us know? Can you list any past animals within the last 3 years? Any behaviors in a new animal you can not work with?
Your answer
A copy of your responses will be emailed to the address you provided.
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