Adoption Application | Western Illinois Ani

The purpose of this application is simple; we care deeply for the animals under our supervision. It is our responsibility to find permanent, loving homes for these animals. We do have adoption guidelines and we reserve the right to deny any adoption we feel unsuitable.

You must be 18 years of age to adopt.

First name

Last name

Spouse/Other Adults in the Household (First & Last name)

Address

Phone

Email

Animal Name

If animal is no longer available, are you interested in another?

Yes

No

Maybe

Are you over 18?

Yes

No

Place of Employment & Phone Number

Do you live in a:

House

Apartment

Condo

Mobile Home

Do you live with relatives?

No

Yes--if yes add name/phone number

Do you:

Own

Rent-Please add Landlord's name and phone number

Do you have a fenced-in yard?

No

Yes--please add how tall and what type of fence

Are there children in the household

No

Yes--please include number of children and ages

Please share how many dogs and cats are currently in the household

Current pets' names

Please share number of dogs and cats currently in the household.

If you have other animals are the spayed/neutered?

Yes

No

If you have other animals are they current on vaccinations?

Yes

No

Have you had other pets in the past 5 years that you no longer have?

Yes

No

If you had other pets in the last 5 years that you no longer have, what happened to them? Please explain (if euthanized why, age, health problems, behavioral problems, etc.)

Where will this pet spend the majority of its time?

Inside

Outside

Where will this animal spend most of its time when you are home?

Where will this animal spend most of its time when you are away?

It may take your pet a month or longer to adjust to a new home. Are you willing to alow this much time for adjustment?

Yes

No

If needed, are you willing to crate train?

Yes

No

Do you agree to return the pet to WIAR if you can no longer keep it?

Yes

No

Please include name & contact information of all current veterinarians who care for your pets. If you don't have a current veterinarian, name of past vet. If you do not have any current/past pets, please include a personal reference name & phone number.

Please include name/names of current pets that would be listed at the vets referenced.

Do you give us permission to call the vet's office to check to see if other pets' vaccinations are current?

Yes

No

By signing below, I certify that the information provided on this application is true and I recognize that any misrepresentation of facts may result in losing adoption privileges. I authorize investigation of all statements in this application and understand that veterinarians, landlords, other humane agencies, etc. may be contacted. I further understand that the adoption of this animal may be delayed until this information can be verified. If, at any time, a representative from Western Illinois Animal Rescue and/or local authorities determine the animal is being neglected or abused, this adoption will be void and ownership will revert back to Western Illinois Animal Rescue.

Signature

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