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You’re a hero

We’re so glad you are interested in adopting a rescue pet!

Take Me Home

Gwen

Boxer

Baby, , Female, , Medium

Spayed/Neutered
Shots Current

Adopter's Information

First Name of Adopter *

Last Name of Adopter *

Date of Birth *

Email Address *

Address *

City *

State *

Zip *

Home Phone

Mobile Phone *

Work Phone

Employer

What are your hours?

Partner's Information

Do you have a partner/spouse?

Yes No

Veterinary Reference

If you don’t currently have a pet, please fill in the name of a veterinarian you have used in the last five years

I haven't had a pet in the last 5 years

My current veterinarian is *

Address *

Mobile Phone *

Work Phone

I hereby give permission for any veterinarian providing service to me to release medical information on any/all of my animals to Education and Animal Rescue Society. *

Personal References

Please provide three personal references. Only one of your personal references may be a relative.

Reference 1: Full Name *

Phone Number *

Email *

Reference 2: Full Name *

Phone Number *

Email *

Reference 3: Full Name *

Phone Number *

Email *

General Questionaire

Please be as detailed as possible.

How long would the pet be left alone?

Where would the pet stay?

Do you or your spouse/partner travel frequently?

Yes No

If so, how often?

What will you do with the pet when you travel?

What will you do with this pet if you have to move?

Are you able to purchase and use a crate if needed?

Yes No

Do you have a pet door?

Yes No

How would you handle a dog’s potty needs?

How would you exercise a dog?

Where would a dog sleep?

Are you willing and able to commit to behavior and/or dog obedience training?

Yes No

Do you live alone or with family?

Does every adult in the household agree on owning this pet?

Yes No

Do you have children?

Yes No

Grandchildren?

Yes No

What ages?

Do they live in the household?

Yes No

If they do not live with you, how often do they visit?

Do you own or rent?

If renting, how long have you lived at this location?

House or apartment?

Does your landlord have breed or weight restrictions?

Yes No

If yes, what are they?

Pet deposit? We need confirmation of payment of any required pet deposit.

Yes No

Rental manager’s name

Rental manager’s phone number

Do you have a fenced yard?

Yes No

If yes, what type of fence?

If yes, how high?

Do you have a pool?

Yes No

If so, is the area fenced off?

Yes No

Have you owned this breed/mix before?

Yes No

Have you owned a rescued animal before?

Yes No

Have you ever adopted from a rescue group or shelter?

Yes No

If so, what group/shelter?

Have you applied to adopt an animal and been declined?

Yes No

If so, why?

Have you ever given an animal up?

Yes No

If so, why?

What did you do with the animal?

What qualities are you looking for in a pet?

I hereby give permission for an Education and Animal Rescue Society representative to visit your home prior to adoption to do a home check and after adoption to do follow up checks on the pet

Pet Ownership History

Do you currently have any pets, or have you had any in the last five years? Please provide information about each pet, including whether it is spayed or neutered, on heartworm preventive, how and when the pet was acquired, and, if applicable, why you no longer have the animal.

Pet Name

What kind?

Dog Cat

Is/was it de-clawed?

Yes No

How Acquired

Breed

Age

Gender

Male Female

Spayed/neutered?

Yes No

Heartworm preventative?

Yes No

What kind of preventative?

Date last given

Length of ownership

Where does/did this animal sleep?

Where does/did the pet stay while you were away?

Does/did this pet have any problems or conditions?

If you no longer have this pet, what happened to it?

Anything else you would like us to know?

WAYS TO DONATE

Mail Checks

EARS
PO Box 190473,
Dallas TX 75219

Amazon Wish List

Paypal

@earstexas

North Texas Giving Day

Photo credits: Angie Ochoa of Dallas Paws Photography

You’re a hero

Take Me Home

Gwen

Adopter's Information

Partner's Information

Veterinary Reference

Personal References

General Questionaire

Pet Ownership History

Pet 1

Pet 2

Amazon Wish List

North Texas Giving Day