Little Nuggets Application

Name
Age
Address
City
State
Zip
E-mail address
Home Telephone
Work Phone
Occupation
Spouse's Work Phone
Spouse's Occupation
Do you live in a house or apt?
Do you own or rent?
If you rent, landlord name:
Landlord's phone number:
Name of pet you're interested in
Why do you want to adopt a pet?
Do you have children at home; if so list how many and their age's
Where do you intend the pet to stay? indoors / outdoors
Do you have a fence?
What type of fence?
Does it have a gate that can be locked?
Which family member will provide the majority of care for this pet?
When you go on vacation, where will your pet go and who will care for it?
If you move, what will you do with your pet?
If your pet becomes extremely ill, can you afford to pay vet bills for an extended length of time?
How long will your pet be left at home alone?
Will you be using a crate for your pet?
Are your current pets on heartworm prevent?
If so which type?
** REQUIRED INFORMATION **
List all pets you have at this time
Are your current pets spayed/neutered?
*They must be in order to adopt from a rescue group*
Vet's name
Vet's phone number
My Vet (may) or (may not) be used as a reference?
List any previous pets you have owned and what happened to them(list:name-sex-age-breed-reason no longer with you)
Reference Name
Telephone Number
Email Address
I understand and agree that the pet can not be transferred, only returned to Little
Nugget's Rescue (yes or no)
I understand a home visit may be required in order for me to adopt this pet. (yes or no)
Signature and date
      

The pet can not be transferred to anyone other than Little Nugget’s Rescue. If the pet has not been altered yet Little Nugget’s Rescue expects the new owner to do so ASAP. We require you to notify us when this has been done. Little Nugget’s Rescue does not adopt pets to breeders under any conditions, pets are to be altered within 30 days of adoption and will need Veterinarian verifications when this has been done.

It is the adopter’s responsibility to have the adopted pet up to date on shots for the life of the adopted pet.

I have been provided and am in full agreement with Little Nugget’s Rescue terms of adoption. By signing below, I am attesting to the truthfulness of my answers in this adoption application. I understand that falsification of any of the above information will be grounds to disallow the adoption of this pet.