Grassroots Animal Rescue Adoption Form
Pet(s) of Interest *
Your answer
Policy
It is our policy to make sure that each person who adopts a pet is aware of the responsibilities of pet ownership and is capable of and willing to accept those responsibilities. If you decide you and your family are ready for the responsibility of caring for a companion animal throughout its lifetime, please complete this questionnaire to continue the adoption process. Our Board of Directors will review this questionnaire to determine if one or more of our adoptable pets would be a good fit for your family.
Personal Information
Name: *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Second Phone Number
Your answer
Email Address *
Your answer
Please list every individual living in your home, including yourself, and their occupation, relationship to you as well as their age *
Your answer
Do any of your household members have dander/fur/saliva allergies? *
Required
What are their thoughts about having a new pet in the home? *
Your answer
Why are you considering adopting a new pet? *
Your answer
Why are you interested in this particular pet(s) for your family? *
Your answer
Home & Pets
Do you own or rent your home? *
Required
What type of home do you live in? *
Required
If you rent, please provide your landlord's contact information:
This includes their name, office address and phone number
Your answer
If you moved where pets where not permitted, what would you do with them? *
This includes their name, office address and phone number
Your answer
Do you have a yard? *
Required
If you have a yard, is it fenced?
If your yard is not fenced, how will your pet exercise?
Your answer
If your yard is not fenced, where will your pet relieve itself?
Your answer
Do you have a pool? *
Required
If you have a pool, is it fenced?
Do you currently have pets? *
Required
Where will your pet be kept on a regular basis? *
Required
Who will care for your pet on a regular basis? *
Your answer
How many hours per day will your pet be alone during the day? *
Your answer
Where will your pet be kept at night? *
Your answer
Where will you keep your pet while you are not home? *
For example, when you are running errands or working
Your answer
Who will care for your pet if you are out of town? *
Your answer
What does a typical day look like for your household? *
Your answer
What might a typical day look like for your pet? *
Your answer
What qualities are you looking for in a companion animal? *
Your answer
Please answer the following questions about your current pet(s) *
For each pet, please list the name of the pet, the species of the pet, the breed of the pet, the length of time you have had the pet, the pet's current age, if the pet is spayed or neutered, where the pet came from, and if it lives inside or outside. Please be thorough.
Your answer
Please answer the following questions about your past pet(s) *
For each pet, please list the name of the pet, the species of the pet, the breed of the pet, the length of time you had the pet, if the pet was spayed or neutered, where the pet came from, if the pet lived inside or outside, what happened to the pet, and the year you last had the pet. Please be thorough.
Your answer
Have you ever had a pet with behavioral problems? *
Required
If you have had a pet with behavioral problems, how have you handled those problems?
Your answer
Under which circumstances would you give up a pet? *
Your answer
Have your pets ever gotten pregnant or had puppies/kittens? *
Required
If yes, were they bred for:
Please provide any other information about yourself, family, lifestyle, etc. that would help us understand the kind of life this pet would have with you:
Your answer
Veterinarian Reference
Name *
Your answer
Clinic: *
Your answer
Phone Number: *
Your answer
City *
Your answer
State *
Your answer
Who is the name listed on the vet records: *
Your answer
If you have more than one vet or used a different vet for previous pets, please include that information below
Your answer
Cost
The cost of a dog is usually more the first year than each year after because of several one-time expenses. These include the price of the puppy, initial vaccinations ($40-100), and the purchase of supplies like a crate ($25-200), collar ($5-20), and leash ($5-10). After the first year, you can estimate the yearly price of owning a dog as follows:

Food: $150-500
Veterinary Exams: $45-150
Vaccinations: $10-100
Worming and Fecal Exams: $20-40
Heartworm Treatment: $25-130
Grooming: $10-400
Training: $0-500
Supplies: $0-200
Miscellaneous: $100-500

If a dog’s average lifespan is twelve years, buying a puppy and caring for him throughout his life will cost $4,620 to $32,990. You may spend more or less depending on the dog you adopt. Keep in mind that this doesn’t include expenses like emergency medical care.

The cost of a dog is an investment, both of your money and your love. So before you adopt a puppy or dog make sure you’re willing to spend what it takes to keep a pet healthy and happy for his lifetime.

Signature
By submitting this document, you acknowledge that you have answered all of the questions to the best of your ability. Failure to provide accurate information will lead to the forfeit of your application for adoption. You are not guaranteed to be approved for adoption.
Please type your name if you agree *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.