This form is a tool to use as a screening process for potential adopters. This helps provide information to assist our Organization in making a good match between pet and adopter. All information submitted in this form will be kept private and will only be used to help assess in making a good match for our animals and their potential adopters.
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Please complete all questions that apply to you.

To skip a question use the skip ahead arrows in the bottom right corner or, on a mobile device, simply swipe to the next question.

 
Name & Species of Animal interested in:

 
Name of potential adopter

 
Home phone number

 
Cell phone number

 
Work phone number

 
Home address

 
Age groups

Please choose one

 
If under 18, can you provide parental consent?

     
 
How did you hear about this animal?

 
Why are you interested in adopting this pet?

 
Is your home a...


 
Are there children in the house?

     
 
If so, how many and what are their ages?

 
Are all members of the household in agreement in regards to adopting an animal and the commitment that entails?

     
 
If no, please explain

 
Will all members of your human family be meeting the animal you are looking to adopt?

     
 
If no, please explain

 
Will any of your existing pets be coming with you to meet the animal you are interested in adopting?

     
 
Do all the adults in the home...


 
Please describe your work schedule

 
Are you located in...


 
If located in a town or city, are you familiar with and willing to follow the licensing and pet by-laws?

     
 
If no, are you willing to familiarize and follow these set by-laws?

     
 
In regards to your home, do you...


 
If renting, does your landlord agree to allow animals in and on the property?

     
 
Are you willing to provide your landlords’ contact information or written consent if requested?

     
 
Where do you plan on housing the animal?


 
How do you plan to care for the animal when you are away?

 
If the animal is to be outside, is there easy access to suitable outdoor shelter and water available?

     
 
If you are on a farm or acreage, are you located near any busy road ways?

     
 
If you are on a farm or acreage, how close are your closest neighbors?

 
Are there other pets or animals in the household or on site?

     
 
If yes, please list:

 
If no, have you ever owned any pets before?

     
 
Please list them and include why they are no longer with you:

 
Do you have experience with the following? Please explain (please include any breeds/types you have experience with & how much experience you have).

 
Dogs:

 
Cats:

 
Other animals:

 
Are there any other animals in the house or on site?

 
Are you willing and able to continue with any future medical care for this animal, be it routine or otherwise?

     
 
Are you willing and/or able to continue to provide any future necessary training, grooming and/or any other basic care needs of this animal?

     
 
Are you willing to provide up to three personal references if requested?

     
 
Are you willing to do a home check and/or have periodic phone follow ups with in the first 6 months from adoption?

     
 
Are you willing to contact R.O.A.R. Society in the event you no longer can care for the animal in question?

     
 
Are you willing to sign the adoption contract R.O.A.R. Society provides and agree to what that contract entails?

     
 
What reasons would lead you to have to surrender a pet?

 
Have you ever surrendered an animal before?

     
 
If yes, please explain as to when, why and to who you surrendered the animal to.

 
Questions 49-51 apply to dogs only:

 
Do you have securely fenced yard?

     
 
If no, is there another form of suitable outdoor containment? Please explain:

 
Are you willing to exercise your dog? Please explain:

 
Please read the following carefully:

 
Do you understand and accept that puppies/dogs/cats/kittens can cause damage to your carpets, furniture, vehicles and belongings by chewing, clawing and having accidents? (Animals can get into anything and find anything to chew/claw, including cell phones, remote controls, purses, shoes, ornaments, sofa skirts. Also beware of paint scratches on walls. Animals can jump on vehicles and scratch paint, chew interior, seatbelts etc). Further more, DO YOU AGREE TO RELIEVE AND ABSOLVE ROCKY ORGANISATION FOR ANIMAL RESCUE SOCIETY (A.K.A. the R.O.A.R. SOCIETY) AND ANY OF ITS MEMBERS, OF ANY RESPONSIBILITY FOR SAID DAMAGES, SHOULD THEY OCCUR?

     
 
Do you understand that all our information about the animals we have available for adoption is based on the observation of the foster home or is provided by a third party and therefore we cannot guarantee behavior, breed, age and/ or background? *

     
 
By clicking the below box I hereby certify that the above statements are true and correct to the best of my knowledge and I agree my electronic signature below is the legal equivalent of your manual signature on this Agreement . *

Please write your full name in the following question
     
 
Signature: *

 
Date: *

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