First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Age*

Name of Employer and Phone #*

Are you the homeowner?

If no, list name of landlord/property manager and phone number. *We do call to verify.

If renting, when is your lease up?

Which animal are you interested in?*
Choose an animal: Ace Amora Arnold Arya - *FH -Training Camp Grad Aslan Bender FH Blueberry Pie Bober Buckwheat Casper *FH bonded with Mack (must be adopted with Mack *FH bonded with Casper and Mack *FH bonded with Casper) Catniss *FH* Cheez-it Cherry Pie Chloe Chunky Commander Cricket Dragon Duke FKA Thunder Eggs Elizabeth Ellie Ethel *BONDED* with Lucy (must be adopted with Lucy *BONDED* with Ethel) Frank FH Frankie General FH Gnocchi Jackson Jasper FH Journey Koda - Training Camp Kylo Luciano Pavarotti FH Lucy *BONDED* with Ethel (must be adopted with Ethel *BONDED* with Lucy) Mack *FH bonded with Casper (must be adopted with Casper *FH bonded with Mack and Casper *FH bonded with Mack) Major Mopar Nacho Nolan FH Odin Panda Pepper FH Princess Pumpkin Pie Ritz Rosie Saltine Saraphina Sasha Smudge Spanky Stella FH Stymie FH Taco Tip FH Tower

Do you have a fenced in back yard?

If yes, what is the height of the fence?
Choose one: 4 Feet or Less 5 Feet 6 Feet or Higher Invisible Fencing

Have you owned pets in the past?

If you have had pets in the past, please specify type, size and sex.

Do you understand PRBJ requires our animals to be returned to our center should you need surrender a pet?*
Choose one: Yes No

How long will a new pup/dog be alone without a human while you are at work, etc.?*

Where will pet be kept when you are not home?*

List names and ages of all people living in the home.*

What pets do you currently have? Please include their name, breed, gender, age, size and temperment. *

Are your current pets spayed or neutered?
Choose all that apply: Yes No

Are your current pets up to date on vaccinations?
Choose all that apply: Yes No

Are your current pets on monthly Heartworm preventative?
Choose all that apply: Yes No

What is the name and phone number of your current vet?*

If you adopt a dog and it develops undesirable behavior (aggressive, not housetrained, barking, etc), what will you do?*

How did you hear about Pet Rescue By Judy?

Comments / Is there anything else you want us to know?*

* We may also require home visits.  The great majority of people interested in adopting a pet from our pet rescue organization are pet lovers with one goal in mind – to provide a safe and loving forever home to a pet in need. Judy makes a commitment to find a new home for a rescue pet in need, she also makes a commitment to potential adopters – and that is, to do our best to make sure that the pet you adopt is suitable for your home and lifestyle.

APPLICATION CERTIFICATION: I understand that Pet Rescue By Judy (PRBJ) obtains pets that are strays or from a third party and therefore all information regarding its age, breed, health status and/or temperament is estimated and is not warranted or guaranteed by Pet Rescue By Judy. If I adopt a pet from PRBJ I agree to keep it as an indoor pet, treat it humanely and provide for its medical needs. I will not allow the pet to roam free/become a nuisance or to be used for experimental purposes. I will not sell, give away, destroy or otherwise dispose of the pet without notifying and obtaining permission from PRBJ. I understand that the stated minimum adoption donation is not a reflection of the direct costs incurred by PRBJ for this specific pet and will be applied to the overall general costs of operating a no-kill animal rescue. If I adopt a pet from Pet Rescue By Judy, I agree to keep my contact information current on the PRBJ website so that I may be contacted should my pet become lost and returned to PRBJ. I certify that the information entered on this application is truthful and I have not tried to mislead PRBJ in any manner by my answers. (Name and Date)*