Adoption Application

Potters Angels Rescue Adoption Application
Procedure and Policies

WE CANNOT HOLD DOGS FOR YOU. THIS TAKES UP VALUABLE FOSTER SPACE NEEDED TO SAVE LIVES. PLEASE DO NOT FILL OUT THIS APPLICATION UNLESS YOU ARE READY AND PREPARED TO ADOPT AT THE TIME OF SUBMISSION. THANK YOU FOR CHOOSING TO ADOPT!

Before you fill out an application please be sure that a Rescue is the option through which you are going to choose to add an addition to your family. We are all volunteers at Potter’s Angels Rescue- most with full time jobs and families in addition to volunteering and going through the entire adoption process with an applicant takes up a fair amount of valuable time and resources. We would like our volunteers to focus their efforts and time on those applicants that are serious in helping a rescued animal.

Our policy is to adopt to people that are 21years of age or older. This is not a first come/first serve procedure as we take great care in matching our dogs to prospective homes. Once the references have been checked on your application, and you have been approved as an adopter, our representatives will schedule a zoom call with you and the foster to review paperwork and answer any questions or concerns to ensure this is a good match for the dog. If it is determined to be a good match, you will schedule a meeting with the foster and dog at that time. The adopter will be expected to travel to a foster’s home to pick up their new family member and finalize the adoption.
Applicant Information
Full Name*

First NameLast Name
Age*
Phone Number*

Area CodePhone Number
E-mail*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address (if different from Physical)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best Way/Time to Contact You
Which Animal are you Specifically Interested in Adopting?*
Employer*
Hours worked per day/week*
Spouse/Partner Information
Spouse/Partner's Name
Age
Phone Number

Area CodePhone Number
Employer
Number of hours worked per day/week.
Other Household Member(s) Information
If there are any other adults (18+) in the home, please list their; names, age, gender and relationship to you.*
If there are any children living in the home, please list their; name, age, gender and relationship to you.*
Does anyone living in the home have any known allergies to animals?*
Home Information- please call your landlord and give your permission to check your references. Not doing so may delay processing your application
Landlord Name (If you live at home with your parents, then your parents are your landlord).*
Landlord Phone Number*
Home*

RentOwnLive with your Parents/Family
If you own, who is your home insurance provider? (Some have breed restrictions)
Type of Dwelling*

Single Family HouseDuplexSinglewide TrailerCondoTown HouseApartment
How long have you lived in your current residence?*
Are you planning on moving within the next 5-10yrs? If yes, then why, when, and where to?*
Do you have a fenced in yard? (not required for adoption)*
Do you plan on using a.....for the dog?*
Current Animals- please call your veterinarian and give permission for them to release information to us- not doing so may delay the processing of your application
What breed/type of animal do you have the most experience with?
Current Veterinarian Clinic Name and Phone Number*
Please call your vet in advance and give them permission to release information to us. Not doing so may delay the processing of your application.
Are there any animals that currently live in the home?*
If Yes, please inform us of their; species, breed, age, gender, and how long you have had them. If the animals belong to a roommate, please give us the name of your roommates vet clinic.
Previous Animals
Use this space to let us know all the animals you have owned in the past 10yrs. Please list their name, species, gender, age, and reason why you no longer have them,.*
Have you ever had to rehome an animal to another person/family, rescue organization, shelter/humane society? If yes, please explain the situation.*
Anticipated Plans/Daily Routine
Please describe your typical day*
Where will the animal be left when alone?*
How many hours per day/night will the animal be left alone?*
Where will the pet sleep at night?*
Which of the following statements would you use to describe you and your life style?*

Highly Active, looking for dog to join on regular hikes/runs, I will work the dog daily and enjoy the challenge of a high drive dogModerately Active, looking for a dog that would enjoy hikes/exercise, but not require it every dayLaid Back, looking for a dog that can be playful, but also likes to Netflix and chillVery Low Activity Level, looking for a couch potato to cuddle with
How much money do you anticipate this animal will cost you on a yearly basis? Please explain your answer.*
General Questions
Why are you considering adopting a pet? Check all that apply.*

Companion for other petFamily PetChild's PetCompanion for SelfGuard/Watch DogBreedingGift For SomeoneReplacement of Recently Deceased PetExercise Companion
What is your training style/preference? If you don't know much about training or have an approach that you prefer, what would you do if your dog peed on the floor? Please explain.*
What would be a reason that you may return this pet? (ie sickness, biting, barking, not house trained, etc)*
In the event of a medical emergency or you are otherwise incapacitated and unable to care for the animal, do you have a plan for their care in place? Please explain.*
Have you applied to adopt an animal from another rescue organization within the past 3 months? If yes, please list the organization(s).*
Please list 4 references below, no more than 2 can be relatives.
Personal Reference #1 Name and Phone #, Email or Text #*
What is their relation to you?*
Personal Reference #2 Name and Phone #, Email or Text #*
What is their relation to you?*
Personal Reference #3 Name and Phone #, Email or Text #*
What is their relation to you?*
Personal Reference #4 Name and Phone #, Email or Text #*
What is their relation to you?*
Are you willing to have a P.A.R representative come to your home to perform a home visit? This is not to judge how clean you keep your house, we do this to get a feel for the environment and whether it is suitable for the dog you are looking to adopt. As an example, some anxious dogs find an open floor plan overwhelming and can benefit from gates being put up. This is just one of many examples on how the home visit can help make the transition smoother for both you and the dog you are looking to adopt. We are NOT looking to judge, we just want successful adoption stories for our dogs and people.*
If you are not comfortable with the home visit, please explain why. Would you be willing to do a video meeting instead?*
Please provide any additional info that may be helpful in working with us to find you a canine or feline for your family.*
How did you hear about Potter's Angels Rescue?
By checking this box I certify that the information provided on this form is true & correct. I understand that proper food and veterinarian care can be costly and I am financially and physically able to care for this animal.*

I Agree
By checking this box I understand that home checks might be made if there are concerns following adoption. If P.A.R finds information contained in this application to be false, P.A.R retains the right to turn down my application or remove the animal from my premises without a refund of moneys paid.*

I Agree
By checking this box I agree to allow a P.A.R representative to contact my; landlord, town clerk office, veterinarian, and personal references in order to verify that the information I have provided is entirely correct.*

I Agree
By checking this box, I am indicating that this is a valid and legal substitution for my written signature on this legal document titled "Potters Angels Rescue Adoption Application".*

I Agree
Should be Empty:

Potters Angels Rescue Adoption Application

Applicant Information

Spouse/Partner Information

Other Household Member(s) Information

Home Information- please call your landlord and give your permission to check your references. Not doing so may delay processing your application

Current Animals- please call your veterinarian and give permission for them to release information to us- not doing so may delay the processing of your application

Previous Animals

Anticipated Plans/Daily Routine

General Questions