Name: *

First Name

Last Name

Phone: *

(###)

###

####

Would you like to receive the ARC Newsletter? *

Yes

No

Do you: *

Own

Rent

Do you live in: *

House

Condo

Apartment

Mobile Home

Interested in: *

Puppy

Adult Dog

Senior Dog

Kitten

Young Adult Cat

Adult Cat

Senior Cat

Looking for: *

Purebred

Small Breed

Large Breed

Long Hair

Short Hair

Hypo-Allergenic

Why do you want a pet? *

Watchdog

Hunter

Companion

House Pet

Breeder

Companion for other pets

For Children

Gift

Other

Is anyone in your home allergic to pets? *

Yes

No

Are you certain everyone in your household wants this pet? *

Yes

No

Do you have access to a fenced yard? *

Yes

No

Do you currently own any pets? *

Yes

No

Does anyone in your residence currently own pets? *

Yes

No

If yes, are they spayed/neutered?

Yes

No

If yes, are they current on their rabies vaccination?

Yes

No

Have you owned any pets in the last 5 years? *

Yes

No

Have you ever given an animal away? *

Yes

No

Have you ever brought an animal to a shelter under any circumstance? *

Yes

No

Do you object to Animal Refuge Center performing a "home" visit? *

Yes

No

Are you ready to make a long-term commitment? *

Yes

No

Are you ready to deal with an animal's possible health challenges? *

Yes

No

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? *

Yes

No

Do you understand the local ordinances concerning Licensing, Rabies law and Leashing? *

Yes

No