contact@pinkdogrescue.org
717-359-9047
Donate Now!
Home
Adopt a Pet
Donations
Events
Application
Home
/
Application
Order Number
First Name
*
Last Name
*
Date of Birth
*
Email Address
*
Home Phone
*
Cell Phone
*
Do you own or rent?
Own
Rent
Address
*
City
*
State
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
*
Please list the pets you have now(Species,Name, Age, Breed, Sex, Spayed/Neutered, Lives inside/outside, Years Owned)
*
Vet Information (Name, Phone Number, Address)
*
Will you give your past/current veterinary office authorization to release medical records to The Pink Dog Animal Rescue?
*
Yes
No
Where will your pet live during the day?
*
Inside
Outside
Crated
If adopting a dog, are you willing to train it?
*
Yes
No
Do you want this pet as a? (Check all that apply)
*
Companion
Gift
To breed
Mouser
Protection
Emotional Support/Guide/Service
Does anyone in your household have pet allergies?
Yes
No
Are you planning to move within the next 6 months?
Yes
No
Most shelter animals have unknown backgrounds. Are you prepared to take this pet to the Veterinarian within 21 days for necessary treatment?
*
Yes
No
Do you understand the state and local ordinances concerning..(Check all that you understand)
*
Licensing
Leashing
Rabies Law
Noise
Spay/Neuter Deposit Refund (Please check one, if you need more information on your choices please ask your pets foster)
Returned to me
Community Fund
Veteran's Program
Please provide 3 references not related to you or living in the same household and their phone numbers.
Which animal are you interested in? (Name and breed)
*
Do you have experience with this breed? (If not we will talk to you about the breed to make sure he/she will fit in with your lifestyle.)
*
Where will your dog stay when you are away?
What is a reason to give up a pet in your opinion?
Do you have a fenced in yard? (You are not required to have one, we just want to know how your dog will get exercise)
*
Information Summary