Adoption Form - Safe With Us Animal Rescue

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Home / Adoption Form

Adoption form

How do I adopt a pet?

Adopting a pet is as easy as filling out the adoption application form, and we’ll reach out to you! Please remember, we’re an all volunteer organization, so it may take a few days – but we promise we’ll be in touch!
Are there any adoption requirements?

At this time we can only adopt to MA, NH and CT residents! Once you apply to adopt, we will perform reference checks, then reach out to schedule a home visit. Please be patient, as all our adoption coordinators are volunteers!
How to avoid picking the wrong pet?

We will work with you to make sure you get a great fit between a dog and your family! Between the information included on your application and the the home visit, we’ll have everything we need to make sure we have a great partnership.
Vet Q&A: Are pets for adoption healthy?

All of our dogs will be spayed or neutered, and will have had a wellness check with a vet! Some dogs may have come from rough lives, but we’ll make sure they are as healthy and happy as can be when they come to their new home!

1Adoption Application Form

2About the dog

3References

4Authorization

Primary Applicant information

Contact information for the primary applicant

Applicant Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Co-applicant?

Yes, I have a co-applicant

Co-applicant information

Contact information for the co-applicant

Co-Applicant Name *

First

Last

Email

Phone *

Address

Same as primary applicant

Address

Address Line 1

Address Line 2

City

State

Zip Code

Primary applicant information

Back to the primary applicant

Over 18? *

Yes
No

Do you:

Own
Rent
Live with a Parent or Guardian

Landlords Name *

First

Last

Landlords Phone *

Home type

Single family
Duplex
Apartment/Condo
Mobile Home

Do you have children in the home?

Yes
No

What ages are the children?

Does anyone in the house have allergies to animals?

Yes
No

List the allergies

I understand that Safe With Us does not allow the adoption of dogs to be placed with anyone but the applicant/co-applicant (i.e. friend or relative). *

I agree

Do you have a specific dog in mind? *

Yes
No

Check our website for the current adoptable dogs.

Which dog do you have in mind? *

Please note, we may may have multiple applications for individual dogs!

Dog description *

Please describe the traits (temperament, size etc) you are looking for in a dog.

Where will the dog be kept?

Indoors
Outside

Do you have a yard?

Yes
No

Is the yard fenced?

Fully
Partially
No

how do you plan on exercising/relieving the dog?

Is this your first dog?

Yes
No

Please list current any other pets you have owned in the past five years

Please include: type of animal, name, age, M/F, Fixed, still have; if no why?

Have you ever surrendered an animal to a shelter?

Yes
No

If yes, why?

Have you ever had a pet euthanized?

Yes
No

If yes, why?

How many hours a day will the dog be without human company?

How will the dog be kept during this time?

Free roam indoors
Indoor crate
Outdoor kennel
Other

I acknowldge I am prepared to properly train my dog *

Yes

Puppies and adult dogs may need obedience, behavior and other training, in one on one, group or other settings.

How will you handle a major life change?

Major life changes such as changes in work or work schedules, divorce, changes in living situation etc happen. What will happen to your dog?

Veterinarian contact information

Current, or prior veterinarian contact details. If this is your first pet, please use N/A.

Name

First

Last

Practice Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email

Personal reference #1

Name *

First

Last

Phone *

Email

Relationship length and type

How long have they known you, and in what capacity?

Personal reference #2

Name *

First

Last

Phone *

Email

Relationship length and type

How long have they known you, and in what capacity?

Personal reference #3

Name *

First

Last

Phone *

Email

Relationship length and type

How long have they known you, and in what capacity?

I agree to allow a home visit prior to adoption *

I agree

Is there anything else you would like to let us know?

How did you hear about Safe With Us Animal Rescue?

Petfinder
Adopt-A-Pet
Friends/Family
Social Media
Other

Adoption Application Agreement

I, the undersigned, understand that this is a basic application for adoption of a dog under the care of Safe With Us Animal Rescue. I understand that an application must be processed, which includes but is not limited to, reference and vet checks, and a home visit. I understand that an adoption of a dog requires full completion of the process and that filling an application out does not guarantee me the dog that I am interested in. Likewise, filling out an application does not mean that I have to adopt the dog that I am interested in.

Applicant Name *

First

Last

Co-Applicant Name

First

Last

Date *

Phone

Adoptable animals

Simon

Meet Simon! He is approximately one year old, and a Lemon Hound. Sweet Simon has...

Flash

Meet Flash!! This big boy is a 1-1.5 year old lab mix who weighs in...

Rooster

Meet Rooster! Rooster is a seven month old hound mix. He’s a funny, lovable, sweet...

Pope

That face!! Meet Pope! This little boy is 7-8 months, and is equally as sweet...

Saint

Look at those sweet eyes! This is Saint, brother to Pope and Trinity. Saint is...

Trinity

Trinity is one of three new babies to join us! She’s 7-8 months old, and...

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