Second Chance Animal Rescue
Pre-Adoption Application

Thank you for considering adopting a shelter animal. This form is designed to help us help you find the right pet for your particular household.  In order to be considered for adoption, you must: 1) be 18 years of age, AND 2) understand that this adoption application must be approved.

Date: ____________________

Name: ___________________________________________

Address: _________________________________________

City/State/Zip: ____________________________________

Daytime Phone: ____________________________________  Best Time: _________________________________

Evening Phone: ____________________________________   Best Time: _________________________________

Employer: _________________________________________  Occupation: ________________________________

Full Time or Part Time: __________________________

Do You:  Rent? ________________    Own? ________________     Live with parents? ________________

If rent, Landlord's Name: ______________________________________

         Landlord's Phone: _______________________________________

Will this cat be kept:     Indoors? _______________  Outdoors? _______________  Both? _______________

Is this cat adoption for: Yourself?  ______________   Family?  ______________   Friends?  ______________ 

If you move, what will you do with your pet(s)? ______________________________________________________

Is anyone allergic to cats in your household?/Who? ____________________________________________________

Are there any children in your household? Yes __________ No __________

         If yes, how many and ages: _________________________________________________________________

Do you have any other pets currently?      Yes __________ No __________

         If yes, types and ages: ____________________________________________________________________
         
         Are your current pets fixed?            Yes __________ No __________
         
Veterinarian's Name: ________________________________________  Phone: ___________________________

What happened to your last pet? _________________________________________________________________

Reference:  _______________________________________________  Phone: ____________________________

Reference:  _______________________________________________  Phone: ____________________________

*** We reserve the right to refuse an adoption to any applicant. ***

Mail to: Second Chance Animal Rescue, PO Box 4867, Youngstown, OH 44515.  Questions?  Call (330) 505-3575.