E-mail Address: * Name of pet you are most interested in: Breed of pet: Your FULL, Legal Name: Home Address: City, State, Zip Code: County: Home Phone number: Cell Phone number: How long have you lived at your current address? What type of housing? Development/Complex name and if there is a weight limit: Do you own, rent or lease to own? If you rent or lease; Landlords full name & telephone number. If you own, the legal owners full name: With whom are you employed? Work Phone number: Spouse/Partner FULL, legal name: Spouse/Partner occupation: Do you or anyone in your home have allergies? Full names and ages of everyone living in your home: What kinds of pets have you owned in the past? What pets do you currently have living in the home? Please include names and breeds Are these pets spayed/neutered? Have you ever had to give up a pet? If so, please explain circumstances: Do you have a completely fenced in yard? Height of fence, and what type of fencing? Dimensions of completely fenced yard: Or if no fencing, please explain how this pet will get exercise and use the bathroom: What member of your family will primarily be responsible for this pet? Will this pet live inside the home? Where EXACTLY will this pet sleep? Where EXACTLY will this pet be when left alone? On average, how many hours per day will this pet be left alone? When you go on vacation, where will your pet go, and who will care for it? If you move, where will your pet go? If you currently rent, and you move, what if you can not find a pet friendly apartment? Veterinarian Name. We WILL call your vet to verify the information you provided. Veterinarian telephone number: Are you willing to allow our Representatives to periodically visit your home? Please tell us a little about yourself and the people living in your home: The average pet can live up to 20 years, are you willing to make this commitment? Yes No Unsure Depends on circumstances Yearly shots average $150, are you willing to pay this? Yes No Unsure Depends on circumstances An average emergency trip to the vet can range from $150 - $500 or more. Are you willing to pay this? Yes No Unsure Depends on circumstances Do you have your pets professionally groomed on a regular basis? If yes, name of grooming salon: Is this pet a gift? Reference #1 Full Name and relation: Reference #1 telephone number: Reference #2 Full Name and relation: Reference #2 telephone number: How did you hear about Brookes Legacy Animal Rescue Team? If for any reason your new pet is not compatible with your family, you MUST return this pet to us. Do you agree to this? Yes No Unsure Have you ever been arrested or convicted for any form of animal abuse? Yes No Refuse to answer Birth date: MM/DD/YYYY Full, legal names and birth dates of everyone living in the home (EXCLUDING children under the age of 18) MM/DD/YYYY Do you know why Brookes Legacy Animal Rescue began? Yes No Sort of How will you address and correct your new pet if he/she scratches, chews or destroys your furniture? How will you address a pet that is not house-trained? If your new pet howls or barks continually, How would you correct and/or address this matter? Are you willing to hire a dog trainer if needed? YES NO I understand that my adoption contribution is a CONTRIBUTION and is NON-REFUNDABLE. * YES NO I understand that there is almost always an adjustment period for my new pet. The average adjustment time can vary from 3 days to 3 weeks. * Yes, I understand and I am willing to make this commitment. No, I want a pet that will adjust immediately. I am unsure at this time. I understand that I am adopting a RESCUED pet that may have medical issues that Brookes Legacy is unaware of. I accept all responsibilities including future medical bills aquired after adoption. Examples include but are not limited to; Kennel Cough, Parvo, Distemper, Coccidia, Giardia, Pneumonia, Ear Mites, Fleas, Ticks, Worms, Mange. * Yes, I agree to accept full responsibility No, I do not agree I am unsure By typing your FULL, LEGAL name in the box, you are stating everything in this application is TRUE. If I have misrepresented any facts my application will be discarded. I understand that adopting a pet is a LIFETIME commitment: * * Required