Adoption Interest Application
Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit their individual needs. We reserve the right to refuse adoption to any applicant for any reason. Please ask for clarification if you have any questions.

UPON APPROVAL, THIS APPLICATION BECOMES PART OF OUR CONTRACT
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What pet are you interested in? *
How did you hear about us? *
Required
If there is a better fit for this animal, would you consider adopting another animal in our program? *
What age range would you be willing to accept? *
Required
Would you consider a cat with special needs or physical restrictions? (Example: FIV+,  FELV+, Blind, paralyzed, skin allergies, etc)  *
Full Name. *
Date of Birth. *
Phone Number: *
Email Address: *
Home Address: *
City *
Are you employed? *
How long have you worked at your current job? (If not working put N/A) *
Do you own or rent? *
Type of housing? *
If rent: what is your landlord's name? (If own put N/A) *
If rent: what is your landlord's phone number? (If own put N/A) *
Will the pet be indoors or outdoors? Please explain: *
What are the names of everyone that lives in the home? *
What are the ages of everyone that lives in the home? *
If you move, what are your plans for your pet? *
How do you plan to address behavioral issues as they arise? *
Under what circumstances would you consider rehoming a pet? (Be specific) *
Other than spay/neuter what elective procedures would you consider? (declaw, tendonectomies, ear cropping, tail docking, dewclaw removal, debarking, devocalization, defanging, etc.) Explain why: *
Estimate annual cost of caring for your new pet:(food, toys, treats, medical care, heartworm prevention, flea and tick prevention, etc.) Explain why: *
Have you ever surrendered an animal to a shelter? If yes explain why: *
List all pets you have had in the past five years: (name, age, spay/neutered, are they still with you?)
Name of veterinarian: (If you do not have one put N/A) *
Phone number of veterinarian: (If you do not have one put N/A) *
Please provide three references below. (One that is not family/friend)
Reference one: (Name, phone number, and relationship to you) *
Reference two: (Name, phone number, and relationship to you) *
Reference three: (Name, phone number, and relationship to you)(not family/friend) *
Please submit a copy of your drivers license via email or text.  
Email: baileyshumanrescue@gmail.com
Text: (919)-351-2383
How did you submit a copy of your drivers license? *
I understand that a home visit/interview is required prior to final placement. *
Required
I understand that a home visit does not guarantee placement. *
Required
I can give a donation of $ _______ (in addition to the adoption fee) to help offset the costs incurred preparing this pet for adoption. (Inability to make a donation does not disqualify an applicant from consideration.) I understand that any donation or contribution is a gift freely given, not a purchase price for a pet. (To Make The Donation Please Visit https://www.baileyshumanrescue.org/donate) *
If approved for a meet and greet I understand I am meeting this animal at my own risk, and indemnify and release Bailey's Human Rescue, Incorporated, its founders, board of directors, volunteer's and Petsense of any and all liability arising from damages to person(s) or property caused by the pet. *
Required
I agree to follow instructions provided by Bailey’s Human Rescue or Petsense to ensure the safety of everyone involved when introducing an animal to myself/another animal, family/friends, and ect. *
Required
By signing below you agree that you answered all questions above truthfully.   *
Date: *
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When application is submitted it may take you to what looks like a blank page. If you scroll up it should show you that application has been completed. *
Required
NOTICE:
Once we receive your application we will review it and give you a call to schedule a virtual home visit/interview via video call as soon as possible. Thank You!
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