Adoption Application – Barkland Bridges

Personal Information

Pet Name *

First Name *

Middle Name

Last Name *

Phone Number *

Cell/Work Phone Number

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Do you own or rent? *OwnRent

Landlord First Name *

Landlord Last Name

Landlord Contact Information *

Does your residence permit pets? *YesNo

Are you currently employed? *YesNo

Type of employment *Full timePart time

References

(No immediate family or persons residing in the same residence.)

Reference 1 Name *

Reference 1 Phone Number *

Reference 1 Address *

Reference 2 Name *

Reference 2 Phone Number *

Reference 2 Address *

Reference 3 Name *

Reference 3 Phone Number *

Reference 3 Address *

Other Information

Do you have a current veterinarian? *YesNo

Name of clinic *

Location of clinic *

Number of adults living in your residence *

Number of children under 6 living in your residence *

Number of children age 6-18 living in your residence *

Do you currently have any other pets in your household? *YesNo

What type(s) and how many? *

Are your current pets spayed/neutered? *YesNo

Are your current pets up-to-date on all of their vaccinations? *YesNo

If adopted, the pet would be kept: *IndoorsOutdoorsBoth

If not kept indoors, where would the pet live? *

Do you have a fully fenced yard? *YesNo

What is the height of the fence? *

Have you previously applied to adopt a dog/cat? *YesNo

From where? *

Have you ever rehomed a previous pet? *YesNo

Please explain why *

TERMS, CONDITIONS & CONTRACT

TERMS, CONDITIONS & CONTRACT

If for any reason you are unable to keep the adopted pet in the future, they must be returned to Barkland for re-adoption. Under no circumstances should you try to re-home the animal yourself or surrender it to another organization. Unless there are extreme health issues, no pet adopted from Barkland may be euthanized without our written consent.

Barkland reserves the right to repossess any adopted pet in the event that we have significant reason to believe that the animal is being mistreated or if information supplied on this form is found to be inaccurate.

In consideration for the right to adopt the pet stated on my adoption application,

Signature *By signing below, you are agreeing to the terms as outlined in this document. If the terms are not met, you (the undersigned) will be held liable and any necessary legal action may be taken.

Date *