Small Animal Adoption Application Blue Barn Rescue Small Animal Adoption Application Thank you for your decision to adopt a rescued small animal. You are encouraged to look at all the animals available to find one that is best suited to your lifestyle. Blue Barn Rescue reserves the right to accept or deny any applicant or application based on our requirements for adoption and the needs of the small animal being applied for. Completion of the application does not guarantee approval. Any false information provided by the applicant will result in a nullification of your application and contract. You must be 21 or older to fill out this application; NO EXCEPTIONS. **This is NOT the Adoption Contract. Please answer EVERY applicable question. If this application is incomplete, you will receive an error message. Your answers will help us make sure we have the perfect match** Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Please check the type of pet you are interested in adopting: * Guinea Pig Rabbit Hamster Rat Other Please name the pet(s) you are interested in adopting * We recommend you list several pets in case your first choice is not available Please specify WHY and WHY NOW you are interested in this/these pets... * How did you hear about us? * Internet Facebook Instagram Another rescue Word of mouth Freind/ Family Employer * Work Phone * (###) ### #### Are you currently a student? * Yes No My Current Residence is: * House Apartment Condo/Townhouse Mobile Home Farm Do you: * If other, Please explain Own Rent Live with parents Other How long have you lived at the above address? * If less than one year, please give previous address and how long: If you rent, please complete the following: Landlord Phone (###) ### #### Are pets allowed? Yes No Is a pet deposit required? Yes No If yes, has the deposit been paid? (Will be verified) Yes No How many household members? * NAMES and AGES of ALL adults over the age of 18 living in your household: * AGES of ALL children under 18 living in your household: Name of current veterinarian **Please indicate the name which your pets are listed under at your veterinarian's office. Vet phone number: (###) ### #### If this is your first pet and you do not have a veterinary reference, please list two references that do NOT live in your house hold and are NOT a family member. Reference Name First Name Last Name Relationship Reference Phone number (###) ### #### Reference Name First Name Last Name Relationship Reference Phone number (###) ### #### Will the pet reside with you at your current residence? (if not, please explain) * Who will have financial responsibility for providing necessary veterinary care? * If not yourself, please provide name and phone number of financially responsible party: Who will be responsible for the daily care and feeding? * Are you aware of the food and vet care needed for your pet? * Yes No Are you aware of the lifespan of the pet you are adopting? * Yes No Why are you adopting this pet? * Gift for another family member or friend Companion for self/family For breeding purposes For food purposes Other If other, please explain Have you ever owned any pets? Yes No If no, please list reason: Do you currently own any pets? * Yes No If yes, please list breed, sex and age of all pets: If you have owned pets in the past that are no longer with you, please explain what happened to them: Have you ever adopted from a shelter/rescue? Yes No Was it a positive experience? Yes No Have you ever taken an animal to a shelter? If yes, please explain: Are your current pets: Indoor Indoor/outdoor Outdoor only Where do you plan to keep this pet? * Inside Outside Inside and Outside Are your current pets spayed or neutered? Yes No Do you plan to spay/neuter this pet? * Yes No If you move, what do you plan to do with this pet? * If you become ill and incapacitated, what do plan to do with this pet? * Do all members of your household want this pet? * Yes No If NO, please list who is not in favor, and why: Are you prepared for common pet behavior problems, such as skittishness, nipping, etc...? * Yes No If NO, please list what you are not prepared to deal with: **Please note that most of our pets come from high kill shelters. Many times we do not have background information on these pets, or any other medical history than what is provided, and what our own vets can tell us. While we work extensively on behavior and temperament, we do not “temperament” test. This is why we will ALWAYS take our pets back if it does not work out, in fact, that is a requirement.** * Applicant please initial that you have read and understand the above: The information submitted on my application above and on previous page is true and correct to the best of my knowledge. I understand that by signing this application, I agree to the liability waiver terms in the event that I visit Blue Barn Rescue as part of the adoption process. * Applicant's Signature Date * MM DD YYYY Thank you for submitting your application! We will review your application and someone will get back to you within 24-48 hours. To view liability waiver terms, click HERE.
