Adoption Application Step 1 of 5 - Personal Information 20% Personal InformationName(Required) First Last Email(Required) Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home/Cell Phone(Required)Occupation/Employer(Required) What animal are you interested in adopting?(Required)If the animal you are interested in is unavailable, would you be interested in hearing about another?(Required) Yes No Household InformationHow many people reside in your household? What are the ages for all individuals in your household?(Required)Are there any people in your household with special needs?(Required) Yes No Do you own or rent your home?(Required) Own Rent Length of time you have been at this address?(Required)Did you receive the approval of your landlord to have a pet?(Required) Yes No Please provide your landlord's name and phone number:(Required)Do you belong to a Homeowners Association (HOA)?(Required) Yes No Please provide your HOA name and contact information. How many pets are you allowed to have?(Required)Is your yard fenced?(Required) Yes No What type of fencing, what is the height?(Required) Animal Care InformationHow much time will the pet be spending alone during the day?(Required)Where will the animal be kept when left alone?(Required)Where will the pet sleep?(Required)Describe how you will train the pet(Required)Have you ever had to surrender a pet?(Required) Yes No If "yes," please explain(Required)Please provide your veterinarian’s name and telephone number(Required)Do you have other pets?(Required) Yes No If so, please describe (type, age, sex, breed, spayed/neutered)(Required)Are your cats and dogs current on their vaccinations, rabies and heartworm protection?(Required) Yes No What happened to your previous pets?(Required)How often will the pet be exercised?(Required) ReferencesHave you ever been convicted of a felony?(Required) Yes No If yes, please explain.(Required)Please provide 2 references that are not related to you(Required)Please share links to your social media profiles or personal websites that you feel represents who you are. (OPTIONAL) AgreementTerms of Service(Required) I understand that once an adoption fee is paid in full, that fee is non refundable. I understand that Kerrville Pets Alive cannot guarantee the breed of the dog that I am adopting. I agree that the above described animal is being adopted by me solely as a pet for myself and/or my immediate family. I agree that I will not sell, give away, abandon or otherwise dispose of said animal to any person(s), dealer, retailer, auction, humane society, animal control, institute or any other entity for any reason. If at a later date I am unable to keep this pet, I agree to first contact Kerrville Pets Alive, and they will be given the opportunity to reclaim said pet at no charge. I understand that any potential adoptive family the adopter would like to transfer ownership to must fill out the same adoption questionnaire as well as this contract and the final decision shall be Kerrville Pets Alive’s. I hereby agree to allow and respond to inquiries, either by email, text, or phone calls, to ensure that the above described animal is adjusting well and is happy. This is also to assist you, the adopter, and to answer any questions or concerns you might have. I hereby understand that the above described animal can be reclaimed/taken back if any part of this contractual agreement has been broken and/or the above described animal is not cared for. I understand that the animal I am adopting is a rescue and that Kerrville Pets Alive has done their due diligence in properly vetting said animal. Any and all medical care after adoption is solely my responsibility and Kerrville Pets Alive has no responsibility in the future vetting or care of this animal after adoption. My adopted Kerrville Pets Alive animal will NOT, under any circumstances, live outdoors. My adopted Kerrville Pets Alive animal will continue to be on flea and heartworm medication, as well as have their yearly vaccines at my expense. It can take up to 6 months for a dog to test positive for heartworms. At the time of adoption, I understand my adopted animal has tested HW negative. It is my responsibility to keep my adopted animal on HW prevention in order to ensure they continue to be free of heartworms. I agree to contact Kerrville Pets Alive if my adopted animal goes missing, or if I wish to relinquish the animal. I understand that if I am no longer able to care for my Kerrville Pets Alive adopted animal, that I will contact Kerrville Pets Alive immediately. I will not sell or give away my Kerrville Pets Alive animal. I will commit to fostering said animal until another foster or adopter can be found. I understand that the health, age, nature, breed or temperament of the Kerrville Pets Alive adopted animal is not guaranteed. I understand that said critter is a rescue that has come from the streets or shelters and there is no history on this animal. I agree to hold Kerrville Pets Alive and all volunteers harmless and under no accountability for any liability or damage. Kerrville Pets Alive is not liable for loss, damage to personal property or harm to any person or animal. I agree that signing or typing of my name below serves as agreement and release of all conditions stated. I understand that by signing this form I may be subject to a background check and screening. Signature(Required)I certify that the information on this application is true. I give permission for you to contact my personal references, HOA, landlord, and veterinarian’s office. Please enter your name, and today's date:Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.
