Lifeline Animal Rescue - Warren, NJ

All questions marked with a * must be completed.

* This is an adoption application for a:

Cat Dog

* Name of the animal you would like
to adopt:

Personal Information

* Name:

* Address:

* City:

* State:

* Zip:

* Home Phone:

Cell Phone:

* Email:

Employed by:

Work Phone:

Adoption Information

* Why do you want this pet?
(check all that apply)

Companion
Gift
Mouser
Companion for other pet
Other, please explain:

* Number of people in home:

* Number of children:

Ages:

* Type of housing:

Apartment
Condo
Duplex
House

* Do you...

Rent
Own
If rental:

Landlord's name:

Landlord's phone:

Are pets permitted?    Yes No

* How long will the animal be
left alone during the day?

* Where will the pet be kept
while alone?

* Does anyone in your household
have known allergies to animals?

Yes No

* Where will the animal be kept?

Indoor Outdoor Indoor/Outdoor

Current and Past Pet Information

* Do you have pets now?

Yes No

Has your current pet(s) been
around other cats/dogs before?

Yes No

How do they react?

* Did you have pets in the past?

Yes No

Type of Animal	Breed	Name	Age	Cause of Death	Year of Death

Veterinarian Information

* Vet's Name:

* Address:

* City:

* State:

* Phone:

For Cat Adoptions Only

* Do you plan to declaw the cat?

Yes No

* What will you do if the cat
claws furniture or shows other
destructive behavior?

* A cat can live 15-20 years.
Are you financially prepared and
willing to give this animal
the medical care it requires
for its lifetime?

Yes No

* Will you permit a volunteer
to do follow-up calls and/or
home visits for the purpose of
assuring proper care and
adjustment of the animal?

Yes No

For Dog Adoptions Only

* Do you have a fenced yard?

Yes No

* What is the height of the fence?

* Do you have a dog pen?

Yes No

* A dog can live 12-18 years.
Are you financially prepared and
willing to give this animal
the medical care it requires
for its lifetime?

Yes No

* Will you permit a volunteer
to do follow-up calls and/or
home visits for the purpose of
assuring proper care and
adjustment of the animal?

Yes No

Once you submit your application, your information will be sent to Lifeline Animal Rescue.
When your information has been received and reviewed, a representative will contact you.
Completing this application DOES NOT guarantee adoption.