| Animal Interested in Adopting:: |
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| First and Last Name: |
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| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| Street address, city, state, zip: |
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| Name of veterinary clinic for current and/or past pets:: |
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| Phone number of veterinary clinic for current and/or past pets:: |
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| Person's Name on Veterinary Account:: |
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| Please list all current pets (names, breeds, sex and ages):: |
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| Please list all pets (excluding your present pets) you have had in the past 5 years, and where they are now:: |
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| If deceased, what were the causes:: |
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| Are your past/present pets spay/neutered?: |
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| Are all your past and present pets current on vaccinations and heartworm preventative (dogs)?: |
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| What vaccinations or treatments will you keep your new pet current on?: |
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| What brand of food do you plan to feed your new pet?: |
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| What is your estimated annual cost of care for the pet you are thinking of adopting?: |
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| What would you do if emergency or general medical care exceed $1,000 dollars?: |
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| Type of residence:: |
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| How long have you lived at the current address?: |
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| Do you rent or own?: |
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| If renting, lanlord's name, phone #: |
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| My yard is:: |
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| Please check all that apply. How do you plan to give your pet daily exercise? |
Fenced in yardLeash walkJogging/runningDog ParkDay careToysDog doorOther petsFetchHikingOff leash walks |
| Type of pet you were thinking of adopting:: |
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| Reason for wanting to adopt a new pet:: |
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| How long have you been considering adopting a new pet?: |
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| Are you seeking a: |
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| What breed of pet are you seeking to adopt?: |
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| What size of a pet are you seeking to adopt?: |
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| What age of a new pet are you seeking?: |
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| Will the pet be kept outside or inside the majority of the time?: |
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| Will the pet have unattended access to outside?: |
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| What is the maximum length of time the pet will be outside unattended?: |
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| When outside, where will your pet be kept?: |
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| Please check how/where your pet will relieve themselves: |
Fenced yardUn-fenced yardLeash walkOutside kennelYard pully runDoggie doorLitter boxIndoor puppy/wee-wee padsFree roam |
| Briefly describe how your pet would spend their day:: |
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| How many hours a day do you have to devote to your pet's care? |
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| Number of hours pet will be home without human companionship?: |
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| Where will your pet be kept during the day? |
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| Please check the applicable daily activities, if any, that your pet will have while you are away: |
Day CarePetsitter |
| Where will the pet be kept at night?: |
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| Please check the applicable daily or other activities, if any, you and your pet will partake in: |
Dog ParkJoggingPlayWalks |
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FlyballDisc DogCoursing/RacingPulling |
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HuntingHerdingWorkingSchutzhund/protection |
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Obedience TrainingAgility TrainingPuppy Training |
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Therapy dogCanine Good CitizenSearch/Rescue |
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CampingHikingBoatingTravel |
| What is the preferred activity level of the new pet you are seeking?: |
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| Please describe the type of personality/activity level of a new pet that would best fit your lifestyle (activities, etc.): |
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| What behavior would cause you to return your pet to the adopting organization?: |
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| Concerns you or your family may have about adopting a new pet:: |
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| Have you adopted a pet from another organization before?: |
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| Have you ever brought an animal into a shelter before, if so, when where and why: |
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| If yes, where and when, and pets name:: |
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| Do any family members have known allergies to pets?: |
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| If yes, please explain:: |
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| What coat preference do you have for your new pet?: |
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| What is your preferred amount of necessary grooming care?: |
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| What is the activity level of your household?: |
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| Number of adults in household:: |
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| Household relationship status: |
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| Number and ages of children in household:: |
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| Do children visit your home?: |
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| Ages of children that visit your home: |
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| Who will be the responsible caregiver of your new pet? If another, what is their relationship to you? |
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| Employer name, address and phone number:: |
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| You and/or your pet's secondary (if applicable) caregiver's employment position and title: |
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| Your pet's responsible caregiver's work schedule: |
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| Your pet's secondary (if applicable) responsible caregiver's work schedule: |
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| Please provide the name and telephone #s of three personal references (non-family) that can be contacted as part of our routine screening process. Examples of acceptable references would be neighbors, co-workers, employers, fellow club or church members, etc.:: |
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| Type of Application:: |
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| Animal Rescue of Illinois takes every effort to protect the privacy of each adoption applicant; however, by completing, and submitting the above adoption application, you are agreeing that you are 21 years of age or older and that ARI has the right to verify any information on the application.: * |
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| First and Last Name:: * |
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