Save The Animals Rescue Society(STARS), Inc.
City, State Zip Please be sure to enter "City, ST(space) zip":
Home Phone: Work Phone: Cell Phone: E-mail:
Drivers License: Date of Birth:
Veterinarian's Name: Clinic Name: Veterinarian's Phone:
Which dog would you like to adopt?
You want your new pet for:(Circle all that apply) House pet Hunter Companion Gift Guard dog Companion for pet Fighting dog
Is this pet specifically for your household? Yes No Explain:
How many pets do you have in your home now?
Please list names, ages, and breeds of current pets:
What type of heartworm protection are they on?
Have you adopted a pet from STARS before? Yes No
Have you surrendered a pet before? Yes No Not to STARS If yes, why?
Where will you keep your pet during the day?
Where will you keep your pet during the night?
Is your yard fenced? Yes No
Living Arrangement? Rent an apartment Rent a house Own your residence
If you rent, does your landlord permit pets? Yes No Landlord Name: Landlords Phone Number:
Do you work? Yes How many hours per week? No
How many people are in your household:
List names and ages:
Please Enter any comments
I agree that, if allowed to adopt, I will not hold STARS liable for any direct or consequential damage arising from the adoption. I agree that if I must give up this pet for any reason it will be returned to Stars. I agree to follow up on all vaccinations as recommended by my veterinarian. I agree to give this pet adequate time to adjust to its new home. I agree to work with a Behavior Counselor should the pet develop behavior problems. I agree to allow follow-up calls by Stars on the new pets progress. I understand that submitting this application represents permission for my veterinary to disclose the treatment history for my previous and current pets to the designated representative of the STARS organization.
I certify that all information I have given is true, and that false information may result in nullifying this adoption.
I agree I do not agree.
Thank you for completing our questionnaire. We will make every effort to match the needs of our adoptable animals with the right family. If you have trouble submitting this application, please turn off all firewall software while submitting.
Nick Rudolph © All rights reserved