First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Cell Phone*

Which animal are you interested in
Choose an animal: Brittany Carson Cash DeLuca Hank Karev Marsh Marsha Meredith Michaela O Malley Orbit Riggs Shepherd Skeeter (must be adopted with Smokey) Smokey (must be adopted with Skeeter)

Other animal not listed above?

Is it okay to text you?*
Choose one: Yes No

Date of Birth*

Employer*

Applicant #2 (if applicable) First Name

Last Name

Phone Number

Is it okay to text you?
Choose one: Yes No

Date of Birth

Employer

Do you own or rent your home*
Choose one: Rent Own

Landlord Name (if Applicable)

Landlord Phone number (if applicable)

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

Length of time living at present address*

Please list the ages of all other people living in the home*

Please list your current pets (including breed, gender & age)*

If you currently have pets, are they all spayed/neutered?*

If you currently have pets are they all up to date on vaccinations? If not, please list any medical reasons they aren't.*

Do you have a regular veterinarian? By providing Ellie's Legacy with this information, you are allowing us to contact your veterinarian. Please call your vet and authorize the release of information to Ellie's Legacy Pet Rescue. *
Choose one: Yes No

What Applicant name are your pet's listed under*

Veterinarian's name(s). Please list all veterinarians your pets have seen for vaccinations and altering*

Veterinarian(s) Phone Number(s)*

Do you agree to provide regular healthcare by a licensed veterinarian?*
Choose one: Yes No

If adopting a kitten, do you agree to have the pet spayed/neutered at the appropriate age? This is included in our adoption fee, if using our veterinarian. You will receive details on that appointment.*
Choose one: Yes No

We do NOT allow declawing of any adoptive cat. Do you agree to NOT declaw at any time? Please reach out to us for safe alternatives.*

List any pets you have owned in the past 3 years that currently you do not own and why:

Will the cat be kept indoors at all times unless in a carrier or enclosed playpen or on a harness?*
Choose one: Yes No

How much time will the animal spend alone during the day?*

Non-Family Reference #1 Name*

Non-Family Reference #1 Phone Number*

Non-Family Reference #2 Name*

Non-Family Reference #2 Phone Number*

Are you willing to let a representative of Ellie's Legacy Pet Rescue visit your home by appointment?*
Choose one: Yes No

Are you willing to stay in touch with Ellie's Legacy Pet Rescue and give us occasional updates on the pet you adopt?*
Choose one: Yes No

How did you hear about us?

Is there any other information you would like to share with us?