It Takes A Village 
​Rescue and Adoption
 910-514-4176
 706-980-0702
a non profit organization
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ADOPTION APPLICATION

Name:
Current FULL Address:
Phone:
E-mail:
Type of Home (house/apt./mobile):
Dog you Want to Adopt:
Own/Rent? (If Rent, are you allowed pets)?
# of Individuals in household:
Ages?
Describe your yard size (fenced? type? height?):
Will you use a Crate?
How often?
How will you exercise dog?
Employer:
Phone:
Occupation:
Name of a relative not residing with you (Emergency Contact):
Address (City/State/Zip Code)
Phone # of relative/Emergency Contact:
Relationship:
Describe your yard (size, fence height, and type):
# Hours of Day dog will be crated:
Current pets (names and ages):
Personalities:
Vaccinated?
On Heartworm Prevention?
Have a current Rabies vaccine?
Describe your relationship to them and things you enjoy doing with them?
References 2 reuired (Names/Relationship(non related) /Phone Numbers)
Please tell us any other Relevant Info you would like us to know:
Electronic Signature (First and Last Name):
Date:
Name & Phone # of Landlord (if Rent):
Name of Veterinarian:
Veterinarian Phone #:
Veterinarian's Address:
Have you ever rehomed or lost a pet? please explain
Any pet allergies in your home?
Date of Birth:
Submit