Name:	* required
Co-Applicant:
Address:	* required
City,State,Zip:	* required
Home phone:	* required
Cell phone:
Work phone:
Email address:	* required
A complete answer to the following questions will enable us to be more familiar with your request and requirements and will help us find the Rescue animal to match your needs and expectations. **** GENERAL QUESTIONS ***
How did you hear about us?	* required
What Old Fella animal are you applying for?	* required
Who is the animal primarily for?	* required
*** INFORMATION ABOUT YOUR HOUSEHOLD ***
Please list all the members of your household with their ages & occupations:	* required
Current Dog(s) - Name, Age, Breed, Gender, Altered, Comfortable with dogs?	* required
Current Cat(s) – Name, Age, Gender, Altered, Comfortable with dogs?	* required
Current Other Pet Types - Type, Age, Comfortable with dogs?	* required
If you do not have a dog/cat now, have you ever owned a dog/cat for which you were the primary caretaker?	yes no
If yes, what happened to the animal?	* required
If you do not have small children living in your home, will your Rescue Animal come into regular contact with any children under the age of 10?	yes no
If yes, how often and what ages?
Does anyone in your house have allergies?	yes no
If yes, what kind?
Do you own or rent your home?	own rent
How long at current residence?	* required
If you rent, has your landlord provided written permission for you to have a dog?	yes no
Please provide your landlord’s name & phone #:
Do you have a fenced yard?	yes no
If yes, please describe the fence:	* required
If you are adopting a cat do you plan on keeping the cat indoors?
*** INFORMATION ON THE CARE OF YOUR DOG ***
Who will care for, train and exercise the Rescue animal?
How will your pet be exercised?
Where will your pet be kept during the day?
Where will your pet be kept at night?
On a typical day, how many hours will your pet be left alone?
Will your dog be allowed in the house?	yes no
Will the dog have free run in the house?	yes no
Are you familiar with crate training?	yes no
Do you plan to use a crate for your new pet?	yes no
Do you plan to keep your dog tied or on a runner outside?	yes no
Will the dog live in the yard?	yes no
Will the dog be allowed to run freely outside of the fenced yard?	yes no
It is strongly recommended that to build a bond with your new dog and establish the ground rules in your family that you enroll in a positive reward-based training class after your dog has settled into your home.  Will your dog(s) receive formal obedience training?	yes no
If yes, please identify the animal trainer.
If you ever have to move, what would you do with your pets?
Why do you think you would be a good adopter of a rescue animal?
*** REFERENCES ***
Veterinarian's name, address and phone:	* required
Previous vet's name, address and phone,if you had one:
Personal reference(Not a relative):  name, relationship, address and phone	* required
Personal reference(Not a relative):  name, relationship, address and phone	* required
*** MISCELLANEOUS QUESTIONS ***
May we visit your home prior to approval?	yes no
Are you aware that routine costs of maintaining a dog can be at least $500 a year (for food, shots, checkups, heartworm & flea prevention, grooming, etc.)?	yes no
Have you sold, given away, or surrendered a pet to a shelter, pound or Humane Society?	yes no
If yes, please explain the details.
Do you understand the state and local ordinances concerning licensing?	yes no
Do you understand the state and local ordinances concerning leashing?	yes no
Have you or any member of your family/household been cited for leash law violations or animal cruelty?	yes no
If yes, please explain the details.
*** AGREEMENT *** I/We attest that I/we understand that OFBCAR makes no guarantees or statements regarding any dog's age, breed, health, or temperament. While OFBCAR has made every effort to provide accurate history and assessment of all of the animal, OFBCAR is not able to guarantee any animals age, breed, medical status or history, behavior or disposition. I/We hereby release OFBCAR and its employees, directors, members and representatives of any and all possible claims arising from injury or damage caused by any animal adopted by me/us to any person or property or relating to the health or temperament of the animal, including any expenses related thereto. I/We attest that the Terms and Conditions of Adoption as stated in the Adoption Contract have been read in full by me/us and I/we understand that this is part of the adoption process and will be enforced.  I/We attest that the information provided on this application is true and accurate to the best of my/our knowledge.  I/We attest that we have retained a copy of the Adoption Contract and also understand that completion and submission of this application does not guarantee adoption of a Rescue animal.  If filling out the application electronically, your name below substitutes for a signature.
Type your name here, as your signature:	* required
Date:	* required
Co-applicant: type your name here, as your signature:
Date: