Rescue Dog Adoption Application

Squeaks and Wheeks Small Animal Rescue
Squeaks and Wheeks Small Animal Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Squeaks and Wheeks Small Animal Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete compassionate care including medical care while under our control.
This questionnaire is designed to help Squeaks and Wheeks Small Animal Rescue and yourself determine if a specific species of pet is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Squeaks and Wheeks Small Animal Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Name and species of the animal you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?
Have your children been around small animals before?

YesNo
Does anyone in your home have allergies or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages
Where are these animals now?
Have you adopted from an animal welfare group before?

YesNo
If yes, what group?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
If the pet has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Are you planning of allowing your pet to spend time outdoors?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
What type of cage or pen do you plan on keeping your new pet in?
What circumstances would lead you to give up your new pet?*
If you had to give up your new pet what would you do with him/her?*
How did you find out about Squeaks and Wheeks Small Animal Rescue?*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websitePetSmartOther
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Squeaks and Wheeks Small Animal Rescue

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information