Are you interested in a particular resident? If so, what's their name?
Name:
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First Name
Last Name
Email Address:
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Phone:
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(###)
###
####
Your Address:
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City, State, Zipcode:
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Would you like to receive the ARC Newsletter?
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How did you hear about ARC? If on the internet, what source?
Do you:
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Do you live in:
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If you rent, what is the name and phone number of your landlord, condo association, or apartment complex:
Interested in:
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Looking for:
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Specific Breed?
Why do you want a pet?
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If Other, please specify:
List names and ages of all members of your household:
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Is anyone in your home allergic to pets?
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Are you certain everyone in your household wants this pet?
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Who will be responsible for care for the pet(s)?
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Length of time the pet will be alone on a regular basis:
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Where will your pet be when left alone?
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Where will your pet sleep?
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Do you have access to a fenced yard?
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Type & Height of fence (if relevant):
Do you currently own any pets?
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Does anyone in your residence currently own pets?
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If yes, how many and what kind?
If yes, are they spayed/neutered?
If yes, are they current on their rabies vaccination?
Present Veterinarians name and phone number:
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Have you owned any pets in the last 5 years?
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If yes, where are they now?
Have you ever given an animal away?
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If yes, why did you give the animal away?
Have you ever brought an animal to a shelter under any circumstance?
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If yes, why did you take the animal to the shelter?
If you move, what will you do with your pet(s)?
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Do you object to Animal Refuge Center performing a "home" visit?
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Are you ready to make a long-term commitment?
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Are you ready to deal with an animal's possible health challenges?
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It may take several months for the pet to adjust to your household or another pet. Are you willing/able to work through this adjustment period?
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Do you understand the local ordinances concerning Licensing, Rabies law and Leashing?
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Type your full name as signature and agreement to the above:
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