Grassroots Animal Rescue Adoption Form
Pet(s) of Interest *
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. After we process your application, an Adoption Coordinator will contact you via email.
Personal Information
Name: *
Address *
City *
State *
Zip Code *
Phone Number *
Second Phone Number
Email Address *
Please list every individual living in your home, including yourself, and their age, occupation & relationship to you *
Do any of your household members have dander/fur/saliva allergies? *
Required
What are their thoughts about having a new pet in the home? *
Why are you considering adopting a new pet? *
Why are you interested in this particular pet(s) for your family? *
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
If you moved where pets where not permitted, what would you do with them? *
This includes their name, office address and phone number
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?
If your yard is not fenced, where will your pet relieve itself?
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? *
How many hours per day will your pet be alone during the day? *
Where will your pet be kept at night? *
Where will you keep your pet while you are not home? *
For example, when you are running errands or working
Who will care for your pet if you are out of town? *
What does a typical day look like for your household and pets? *
What qualities are you looking for in a companion animal? *
Please answer the following questions about your current pet(s) *
For each pet, please list the pet's name, species / breed, age, how long you have owned the pet, if the pet is spayed or neutered, where the pet came from, and if it lives inside or outside. Please be thorough.
Please answer the following questions about your past pet(s) *
For each pet, please list the pet's name, species / breed, age, 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.
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?
Under which circumstances would you give up a pet? *
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:
Please note, we are currently unable to transport dogs. If you are approved, will you be able to pick up your dog in Starkville, MS? *
Veterinarian Reference
Name *
Clinic: *
Phone Number: *
City *
State *
Owner’s name listed on vet records: *
If you have more than one vet or used a different vet for previous pets, please include that information below
Application Process
Thank your for your application! The application process allows us to match our adoptable dogs with the best homes for them. After you submit your application, an Adoption Coordinator will contact you via email in 3 - 5 business days. After we process the application, we are happy to set up a time for you to meet the dog(s) you are interested in adopting.
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 *
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