West Tennessee Animal Rescue
Adoption Application
Thank you for your interest in rescuing a homeless pet! Your references will be contacted and you will be contacted for an interview within the next few days.
Name or Pet ID:
*First Name:
*Last Name:
*City: *State: *Zip:
*Best Contact Number   (xxx-xxx-xxxx)
Alternate Phone:
*E-Mail Address:
*Verify E-Mail:
Companion Animals
In the table below please list all companion animals who live at your home followed by all companion animals you have had in the last 5 years. If there are more than 6, list them in the additional comments section. (Altered = Spayed or Neutered)

Name Age Breed Gender Altered What/When happened to this pet?
Additional Questions
Please check all boxes that apply to indicate your agreement with our policies.
By submitting this Adoption Application, I am granting permission for a Rescue representative to contact my veterinarian's, landlord (if applicable), and listed references with the intent of gaining personal information about my lifestyle and the care of my existing and previous animals. I am also granting permission for a representative to conduct an inspection of my home at a scheduled time if necessary.
I am at least 18years old.
Please enter the name of any organizations you have previously adopted a pet from. (Enter Name)
* Do you own your home, rent your home, or live with family? If you live with family, please explain.
* Please list all people living in the house and/or who will have regular contact with your animal(s) and their ages. Please include YOURSELF. Is any member of your household NOT wanting a pet?
* Does anyone living in your home have allergies to pets?
* Do you have a fenced-in yard? If yes, please describe the type of fencing including the locking mechanism on the gate and the approximate size of the fenced area.
* Where do/will your companion animals stay during the day when you are not home? Where do/will they sleep at night?
* How long will you give this pet to adjust to your home?
* How often do you travel and who will care for the pet while you are away?
* What will you do if your new pet has behavior problems? i.e. chewing, not housebroken, requiring lots of attention, etc.
* Are your current pets spayed or neutered, up to date on vaccines and on heartworm preventative? If no, please explain why. If on heartworm preventative, please list the type.
* How did you hear about West TN Animal Rescue?
* Are you willing to spend time and money for obedience training if you experience behavioral problems with this pet?
* If we were to do a background check, would we find any history of domestic or animal abuse?
Veterinarian References:
Please list your veterinarian contact information. Please indicate if the records are not in your name. By providing this information, you are giving us permission to contact your vet.
Primary Vet:
Name on Account:
*Practice Name:
*City: *State: *Zip:
*Phone with area code:   (xxx-xxx-xxxx)
*Animals treated by this vet:
Contact Person:
Secondary Vet:
Name on Account:
Practice Name:
City: State: Zip:
Phone with area code:   (xxx-xxx-xxxx)
Animals treated by this vet:
Contact Person:
Personal References:
Please list 2 persons who are not family members as references. This should be someone who knows you and your companion animals and have been to your home.
Reference 1
*First Name:
*Last Name:
*City: *State: *Zip:
*Phone with area code:   (xxx-xxx-xxxx)
Reference 2
*First Name:
*Last Name:
*City: *State: *Zip:
*Phone with area code:   (xxx-xxx-xxxx)
Employer:(or business, if self-employed)
*Employer Name:
*City: *State: *Zip:
*Phone with area code:   (xxx-xxx-xxxx)
Landlord(if you do not own your home)
If you are currently renting please provide landlord name and best phone number to reach him/her.
Landlord Name:
Landlord Phone:
Additional Comments
Please provide any additional information relevant to this application.
bulletI understand that if my application is approved, I will be asked to sign an Adoption Contract. The Adoption Contract will represent a legal binding document.
bulletApplications are processed in the order in which they are received.
*I agree with the above terms.
I Do Not agree with the above terms.