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: *Holly *BONDED* with Lydie (must be adopted with *Lydie *BONDED* with Holly) *Lydie *BONDED* with Holly (must be adopted with *Holly *BONDED* with Lydie) Amora Aslan Brody *FH Catniss *FH* Chakra FH Chorus Cody Rhodes Della FH Dinky Elly Mae FH Garland FH IceMan *FH Jackson Jasper Jed FH Jethro FH Kayden Carter Leeward Lorax Luna FH Lyric Milburn Minnie FH Mistletoe Mollie FH Monty FH Mopar Mrs. Claus *FH Music PJ *FH Raven FH Ricky Roo Rosie Sasha Shibu Stockings Sunkist Tango Tinsel FH Wreath Zelda *FH the Best Girl!

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 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)*