Pet Adoption Submission – Safe With Us Animal Rescue

Part 1: Applicant Contact & Eligibility - Step 1 of 5

Are you 18 years or older? *

Safe With Us is only able to adopt to Applicants who are at least 18 years of age

I understand that submitting this application to Safe With Us Animal Rescue is the first step in the adoption process. I acknowledge that the process may include reference checks, veterinary checks, and a home visit. I understand that submitting an application does not guarantee adoption of a specific pet, nor does it obligate me to adopt. Final approval is contingent upon successful completion of the full adoption process. *

I understand

Date *

You are unfortunately not able to adopt from Safe With Us. If you are interested in volunteering, please navigate to the Volunteer page

Primary Applicant Contact Information

Applicant Name *

First

Last

Applicant Email *

Applicant Phone Number *

Applicant Address *

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a Co-Applicant? *

Co-Applicant Information

Co-Applicant Name *

First

Last

Co-Applicant Email *

Co-Applicant Phone Number *

Home Type *

Single Family
Duplex
Apartment/Condo
Mobile Home

details prepared Length

What is your current housing situation? *

Own
Rent
Live with a Parent or Guardian

Landlord / Condo Association / Homeowner Name *

Landlord / Condo Association / Homeowner Phone Number *

Please name each adult who lives in the home *

Please include the first and last names of the Applicant and Co-Applicant name and only include members of the home who are at least 18 years of age

Do you have children in the home? *

Please list the child/children's' age(s) *

Separate multiple ages using a comma

Does anyone in the house have allergies to animals? *

Please list the allergies *

I understand that Safe With Us Animal Rescue only allows adopted pets to be placed with the approved Applicant or Co-Applicant. Pets may not be rehomed or placed with another individual, such as a friend or relative. *

I Understand

Are you interested in adopting a dog or cat(s)? *

Do you have a specific dog or dogs in mind for adoption? *

Check our website for the current adoptable pets!

Do you have a specific cat or cats in mind for adoption? *

Check our website for the current adoptable pets!

Are you interested in a specific dog? *

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

Are you interested in a specific cat? *

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

If the dog(s) you’re interested in are no longer available, would you like us to continue processing your application for pre-approval so you're ready to adopt when another dog becomes available? *

If the cat(s) you’re interested in are no longer available, would you like us to continue processing your application for pre-approval so you're ready to adopt when another cat becomes available? *

Do you have a preferred age range for the cat you'd like to adopt? *

Kitten (under 1 year)
Adult (1 to 9 years old)
Senior (10+ years old)

Select all that apply

What is your preferred coat length for the cat you’d like to adopt? *

Short Haired
Medium Haired
Long Haired

Select all that apply

Please describe any preferences you have for the dog you'd like to adopt. *

Tell us about the type of pet you're hoping to adopt. What size, temperament, energy level, or other traits are important to you?

Please describe any preferences you have for the cat you'd like to adopt. *

Include details such as color, breed, personality, temperament, or any other traits that are important to you.

Where will the dog be kept? *

Indoors
Outdoors

Do you have a yard? *

Is the yard fenced? *

How do you plan on exercising/relieving the dog? *

Is this your first pet? *

Are there any pets that currently live in the home? *

Please list your current pet(s) and breed(s) *

For each pet currently in your home, please provide the following:
* Name
* Age
* Species/Breed
* Temperament (e.g., calm, energetic, shy, friendly with other animals, etc.)
* Spayed/Neutered? (Yes/No)

Please list any dogs you’ve owned in the past five years *

For each dog, include the following details:
* Name
* Age
* Sex (Male/Female)
* Spayed/Neutered (Yes/No)
* Do you still have this dog?
** If not, please explain why (e.g., rehomed, passed away, etc.)

Have you ever surrendered an animal to a shelter? *

Please explain why you answered yes to the previous question. Include any relevant details about the circumstances. *

Have you ever had a pet euthanized? *

Please explain why you answered yes to the previous question. Include any relevant details about the circumstances. *

On average, how many hours per day will the dog be left alone without human company? *

How will the dog be kept while home alone or unsupervised? *

Free Roam Indoors
Crated Indoors
Outdoor Kennel
Other

You selected “Other” for how your dog will be kept while alone. Please describe the arrangement in more detail. *

I acknowledge that I am prepared to provide appropriate training for my dog. *

Puppies and adult dogs may require obedience, behavioral, or other types of training—whether one-on-one, in group classes, or through other methods.

Please select the option that best describes your experience with cats. *

First-time cat owner
Currently have one or more cats
Grew up with cats
Have cared for cats with special needs

Do any of your current cats go outdoors? *

Please indicate whether the cat will be kept indoors, outdoors, or have access to both. *

Indoor Only
Outdoor Only
Both Indoors and Outdoors

How will you handle destructive behaviors? *

What behavior(s) will you not tolerate? *

Please describe any circumstances in which you might consider rehoming or returning a cat. *

This helps us understand your expectations and ensure the best match for both you and the animal.

Please confirm that you are prepared to give the cat time to adjust to its new environment. *

I am prepared
I am NOT prepared

Cats may need days or even weeks to feel safe and comfortable in a new home. Patience and consistency are key.

Please describe your plan for helping your new cat adjust to your home and meet other household members (including pets, if any). *

Consider how you’ll manage the first few days, create a safe space, and introduce the cat gradually.

How would you care for your pet during a major life change? *

Life changes—such as a new job or schedule, moving, divorce, or other transitions—can affect your routine. Please share how you plan to ensure your pet's continued care and stability during such times.

Veterinarian Contact Information

Please provide the name and contact information of your current or previous veterinarian.

Do you currently have, or have you previously had, a veterinarian for your pet(s)? *

Please enter the name of the veterinary practice your pet visits. *

This helps us verify medical records and ensure continuity of care.

Please enter the name(s) of your pet(s) exactly as they appear on veterinary records. *

This helps us match medical history and ensure accurate documentation.

Please enter the name exactly as it appears on your pet’s official veterinary documents. *

First

Last

Please enter the full address of the veterinary practice your pet visits. *

Address Line 1

Address Line 2

City

State

Zip Code

Veterinarian Phone Number *

Personal Reference #1

At least one reference must be a non family member

Reference #1 - Name *

First

Last

Reference #1 - Phone Number *

Reference #1 - Email

Reference #1 - Relationship Length and Type *

How long has this reference known you, and in what capacity?
For example: “5 years as a coworker” or “2 years as a neighbor.”

Personal Reference #2

At least one reference must be a non family member

Reference #2 - Name *

First

Last

Reference #2 - Phone Number *

Reference #2 - Email

Reference #2 - Relationship Length and Type *

How long has this reference known you, and in what capacity?

Do you have a third reference? *

Personal Reference #3

At least one reference must be a non family member

Reference #3 - Name *

First

Last

Reference #3 - Phone Number *

Reference #3 - Email

Reference #3 - Relationship Length and Type *

How long has this reference known you, and in what capacity?

Do you agree to allow a home visit prior to adoption? *

This helps ensure a safe and suitable environment for your future pet.

Failed Applicant - Name *

Failed Applicant - Email *

Failed Applicant - Phone

How did you hear about Safe With Us Animal Rescue?

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

You selected “Other” for the previous question. Please submit how you heard about Safe With Us Animal Rescue.

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

You are unfortunately not able to adopt from Safe With Us. If you are interested in volunteering, please navigate to the Volunteer page

Primary Applicant Contact Information

Co-Applicant Information

Veterinarian Contact Information

Personal Reference #1

Personal Reference #2

Personal Reference #3

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