Name (husband and wife, if married):       
Street Address:      
Zip Code:      
Home Phone:      
Cellular Phone:      
Work Phone:      
Email Address:       
Work Hours:      
Is anyone home during the day:  0 Yes  0 No   
At night?  0 Yes 0 No

A successful adoption depends on both the selection of the right pet for your household and the
understanding of his / her individual care taking needs.  So that we may assist you with this
selection, please answer the following questions as completely as possible.  Thank you.

Do you own or rent your home?  0 Own   0 Rent
Type of Dwelling:         
Do you have a fenced yard? 0 Yes 0 No
How many adults are in your household?       
Children?         Ages and genders of children:      
How do other family members feel about getting an animal?      

Which animal pictured on our "available for adoption" page are you interested in?      
Please note that your first choice may have other applications on him/her that could be approved first.
If so, will you consider another?  0 Yes 0 No
Why do you want to adopt this animal?      

Please initial that you understand and agree that adoption is contingent upon your having a fence or
some other similar outdoor confinement area on your property. At no time will you ever tie, stake,
chain the animal in any way to any fixed or growing object or attach the animal to an overhead pulley
or runner system; neither will you allow the animal at any time to run free outside a fenced or
otherwise confined area. Initials      

How many animals have you owned in the last 3 years?      
How many animals do you currently own:  Dog(s)         Cat(s)       Other                      

How many animals are currently in the home?
Dog(s): ____________        Cat(s): ____________        Other: ____________
Breed                                        Years Owned        Age        Spayed/Neutered
New Pet Information
How long have you been looking for a pet?      
Are you committed to providing a responsible home for your pet’s entire life (15+ years)? 0Yes 0No
If you have to move, what do you plan to do with your pet(s)?      
Who in the household will be the dog’s primary care giver?      
Where will the dog be kept during the day?      
During the night?      
How many hours per day will your dog be left alone?      
Are you established with a vet?  0 Yes 0 No        
If yes, who is your vet?        Vet phone number:      
Are your dog(s) microchipped? 0Yes 0No  

Under what circumstances would you consider giving a dog up? Please explain:      

Have you ever given a dog up or had a dog for a brief period of time and it didn’t work out? 0 Yes 0 No
If so, please explain.       

Have you ever look at or applied for a pet with another rescue group? 0 Yes 0 No
If yes, how long ago?        Did you adopt? 0 Yes 0 No  Please explain.      

If you are unable to keep your dog any reason at any time will you return the dog to us? 0 Yes 0 No

If you are considering a long-haired breed, will the dog be professionally groomed? 0 Yes  0  No
How did you hear about Semper Fi Rescue?  0 Petfinder  0 Referral from another group
0 Friend  0 Other, please explain:      

All of the information I have provided on this application is, to the best of my knowledge, true and
complete.  I understand that falsifying answers on this application, or at any other time during the
adoption process, disqualifies me from adoption.

Applicant's Signature:                           Date:                

                             Please fill out Application and send via:
                                             Email to: