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Texas Star Rescue: Adoption Application
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* Indicates required question
Email
*
Your email
Name of animal of interest:
*
Your answer
You and Your Family
Tell us more about you
Your Name
*
Your answer
Home Phone
*
Your answer
Cell Phone
Your answer
Email
*
Your answer
Co Applicant
Name
*
Your answer
Relationship
*
Your answer
Phone
*
Your answer
Preferred method of contact
*
Home Phone
Cell Phone
Email
Required
Street
*
Your answer
City, State, Zip
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Your answer
Are there children in the home?
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Yes
No
If yes, what are their ages?
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Your answer
Do you own or rent your home?
*
Your answer
If you rent, please provide your landlord's contact information:
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Your answer
If you rent, please provide a brief summary of your pet policy:
*
Your answer
Current Pets
Tell us about your current pets
Please describe the pets you currently have (breed, age):
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Your answer
Current or Most Recent Veterinarian:
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Your answer
Current/Most Recent Vet contact information:
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Your answer
Are your pets spayed/neutered?
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Yes
No
Which of the following are your pets currently on?
*
Yearly Boosters
Rabies Vaccination
Heart Worm Prevention
Flea and Tick Prevention
All the above
Your New Pet
How long will the new pet be home alone during the day?
*
Never
1-4 Hours
5-8 Hours
9-12 Hours
13 + Hours
Will they be kept inside or outside while you are gone?
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Inside
Outside
Do you have a fenced yard?
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Yes
No
If yes, please give us a description of fencing.
*
Your answer
If no, which of the following will you be using?
*
Walking on a leash
Runner Cable
Outside Kennel
Other:
Required
Many animals have histories of abuse and neglect. It's important to understand that your new pet will require time to decompress and may not immediately feel comfortable upon arriving at their new home.
*
I understand
I do not understand
It can take up to two months for your new pet to adjust. Which of the following would you NOT be willing to work through until your pet has become adjusted?
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Accidental pottying in the house
Chewing
Barking
Jumping
Digging
Nipping
None of the above
Other:
Required
What reasons would make you consider giving up your pet(s) in the future?
(i.e. moving, new baby, marriage, divorce, etc.)
*
Your answer
Are you prepared to care for your pets into old age (15+ years), and provide them with adequate medical care and treatment for any conditions that may arise as they age?
*
Yes
No
Do you understand that a house broken animal is NOT guaranteed?
*
Yes
No
If you are applying for a brachycephalic breed (flat faced), please answer the question below.
Are you familiar with the health problems associated with brachycephalic breed?
(i.e. heat, cold, over exertion, etc.)
*
Yes
No
Please list any personal references that can attest to the information you provided:
Name, Phone Number and/or Email Address
*
Your answer
By checking this box, I give my permission to Texas Star Rescue to contact my current (or most recent) veterinarian listed above in regard to my current and past pets' medical records. I release the veterinarian named above, their staff and employees from any legal responsibility or liability for the release of information to Texas Star Rescue. I understand I may revoke this authorization at any time, but the revocation may not be applied retroactively once the information specified herein has been released.
*
Yes, I agree.
By checking this box, I agree to Texas Star Rescue performing a preliminary home visit which will be scheduled with me following review of this application.
*
Yes, I agree.
By checking this box, I verify that this information is true and correct to the best of my knowledge.
*
Yes
Required
Digital Signature
*
Your answer
Date
*
MM
/
DD
/
YYYY
Send me a copy of my responses.
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