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: Alexander FH *PUPPY Amora Arya - Training Camp Session 28 Aurora the Adorable *FH Babybelle *BONDED* *FH (must be adopted with Tinkerbelle *BONDED* *FH) Baileyton FH *PUPPY Billy FH the PUPPY Boom Chocolatta *FH Boots *BONDED* with Muffin (must be adopted with Muffin *BONDED* with Boots) Buddy *TRAINING CAMP Graduate* Cardinal Catniss *FH* Cholula Daphnie - Training Camp Session 28 Davidson *FH PUPPY Dothan *PUPPY Duke *FH Elvira - Training Camp Session 28 Finley *FH* Granger - Training Camp Session 28 Granita PUPPY Haribo Harley *FH PUPPY Harriett Hummingbird Jackson Jolly Rancher Kato Laverne the PUPPY Lemmy Little Man Lucky Charms *FH Mallard Mambo Millie FH Mimosa *FH Mopar Muffin *BONDED* with Boots (must be adopted with Boots *BONDED* with Muffin) Nina *FH Peppercorn *FH Philly FH - Puppy Precious Raven FH Rizzoli FH Rumba Sandee *FH Sherman *FH Shirley *FH the PUPPY Smokey - Training Camp Session 28 Sorbet PUPPY Sparrow Sriracha Sweetie Pie *TRAINING CAMP GRADUATE* Sydney Tabasco Tango Tillie *FH PUPPY Tinkerbelle *BONDED* *FH (must be adopted with Babybelle *BONDED* *FH) Trolli Valentina Wallace FH* TRAINING CAMP Graduate* Waltz

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?

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 while you are at work, etc.?*

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

List names and ages of those 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/neutered/up to date on vaccinations and heartworm preventative?

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)*