Adoption Interest Form

Thank you for your interest in adopting one of our animals! This form is the first step you need to take to meet an animal in its foster home or to adopt an animal you have already met. Please completely fill out the form below, then click the "Send application" button at the bottom of this page. Your application will be sent to our adoption volunteers. We are an all-volunteer organization, so please be patient – you will be contacted within a few days. Thank you again!

NOTE: Please be aware that Independent Animal Rescue is an organization of volunteer foster homes, located primarily in the Raleigh/Durham/Chapel Hill area of North Carolina. Due to the nature of our adoption process, we can only consider applications for homes located within 60 miles of the Triangle area. Thank-you!

BASIC INFORMATION
Full Name:	(required)
Adopter's Age:	(required)
Address 1:	(required)
Address 2:
City:	(required)
State:	(required)
Zip Code:	(required)
Home Phone:	(at least one phone contact required)
Work Phone:
Cellphone:
Email address:
Preferred method of contact:
The animal you are interested in is a:	Dog \| Cat (required)
Name of animal or breed of animal you are interested in:	(required)
If you've been in contact with an IAR volunteer, specify who:
What is the intended purpose of this pet? (check all that apply): (required)	Companion for myself/family Companion for another pet Mouser Guard Dog Gift for: Other:
When did you decide to get a new pet?	(required)
What qualities are you looking for in a pet?	(required)
How did you hear about IAR?

List all members of your household. Include family, roommates, or Frequent Visitors:

Name	Relationship to You	Inhabitants	Age	Agrees with getting new pet?	Known Pet Allergies?

Have you had any
pets as an adult?

yes no

Please list all pets you’ve had as an adult, or in the last 10 years:

Name	Breed	Age (yrs)	Kept Current on Vax?	Kept Current on HW Meds (dogs)?	Spayed / Neutered?	FIV / Feline Leukemia negative?	Declawed?	Location Kept:	What happened to the pet?

Have you ever had to relinquish a pet?	yes no
If yes, what were the circumstances?
May we contact your veterinarian?	yes no
Veterinarian's name:	(required if pet owner)
Veterinarian's location (City & State):	(required if pet owner)
Veterinarian's phone number:	(required if pet owner)
Don't have veterinarian information available
Don't have a veterinarian
If you’ve owned declawed cats, what was the reason for declawing?	(required)
If adopting a cat from IAR, do you plan on declawing?	yes no (required)
If yes, why?
ABOUT YOUR HOME
What kind of home do you live in?	Own Home Rent Condo/Townhome Apartment Mobile Home Other
How long have you lived at your current address?	Years: Months:
Do you have permission from your landlord for a pet?	yes no Not Applicable
Your landlord's name and phone number:	(required)
May we have your permission to contact your landlord?	yes no Not Applicable
Do you have a fenced yard?	yes no
How high is the fence?
Does it touch the ground?	yes no
If there is a gate, is it locked?	yes no
CARING FOR YOUR ANIMAL
Who will be the primary caregiver of your animal?
How long are you gone each day?
Where will your animal stay while you are gone during the day?
Are you employed? (required)	Not employed Full Time Part Time Work at home Retired Undergrad Student Graduate Student Military
How far is your job/school from home?
What kind of lifestyle do you want your new pet to have?	(required)
What is your reason for this choice?	(required)
Where will the animal sleep at night?	(required)
How often do you travel?
When you travel, who will care for your animal?
How will you exercise your dog?
How often will you exercise your dog?
How much responsibility will your child/children be given in the care of the animal?	(required)
What will happen to the animal if you move?
What will happen to the animal if you have children?
How would you teach your animal?
What would you do if your animal developed behavioral problems?
Are you willing to take your animal to a veterinarian for an annual physical and vaccinations?	yes no
Are you willing to provide regular flea and tick control?	yes no
Are you willing to provide monthly heartworm protection?	yes no
I understand the minimum medical costs for yearly checkup and vaccinations are at least $150:	yes no
I understand the monthly costs of food and flea/heartworm preventative:	yes no
I am prepared to make a 20 year commitment to this animal:
Name of a personal reference:
Your reference's phone number:
A DAY IN THE LIFE...
Describe what a typical day will be like for this animal if he/she is adopted by you:
Do you have any objections to letting a rescue group volunteer visit your home for a pre-adoption visit or follow-up visit after the adoption?	Objection No Objection (required)
I am a US citizen:	yes no
Are you planning to move overseas or out of the country at any time?	yes no
I am at least 21 years of age. All of the information I have given is true and complete. I understand that IAR has the right to refuse my application:	yes no (required)

Did You Know: Egyptians really respected their cats! They worshiped them as gods, and anyone caught hunting or mistreating them in any way was put to death.

Independent Animal Rescue | Post Office Box 14232 | Durham NC 27709-4232
919-403-2221 | info@animalrescue.net

Adoption Interest Form

BASIC INFORMATION

ABOUT YOUR HOME

CARING FOR YOUR ANIMAL

A DAY IN THE LIFE...