From: Website
to the Rescue <no_reply@website2therescue.com>
Sent: Wednesday,
June 19, 2013 11:56 AM
To: domains@websitesbybarbara.com
Subject: Sample
Adoption Application
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Hello, this email is to confirm that your info has been
received. |
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Applicant Name |
Barbara Lolmaugh |
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Address |
1605 E. Javelina Cir. |
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City State Zip |
Mesa, AZ 85203 |
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Home Phone |
7148135605 |
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Cell Phone |
7148135605 |
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Email Address |
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Number People In Household |
2 |
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Childrens Ages |
none |
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Allergies |
No |
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All Agree To New Pet |
YES |
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Type Of Home |
House |
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Rent Or Own |
Rent |
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Landlord Permission |
Yes |
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Landlord Name Phone |
Test |
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CCR Restrictions |
Yes |
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How Long At Residence |
1 year |
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Move Within 12 Months |
No |
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Move With Pets |
n/a |
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Travel |
No |
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Pets When Travel |
Take dogs with us |
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Why This Pet |
Why Not? |
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Responsible For Pet |
Myself and husband |
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First Pet |
No |
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Where Pet During Day |
Inside |
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Where Pet At Night |
Inside |
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Hours Pet Alone |
2 to 4 hours |
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Commit For Lifetime |
Yes |
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Financial Responsiblity |
Yes |
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Vet Name |
Test |
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Vet Phone |
Test |
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OK To Contact Vet |
Yes |
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Current Pets |
Yes |
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Current Pet1 Type |
Dog |
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Current Pet1 Breed |
ACD / Terrier Mix |
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Current Pet1 Sex |
Female |
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Current Pet1 Age |
5 years old |
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Current Pet1 Spayed Neutered |
Spayed |
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Current Pet1 Where Kept |
Inside |
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Current Pet2 Type |
Dog |
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Current Pet2 Breed |
Great Dane |
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Current Pet2 Sex |
Female |
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Current Pet2 Age |
4 years old |
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Current Pet Spayed Neutered |
Spayed |
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Current Pet Where Kept |
Inside |
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Current Pet3 Type |
3 Cats |
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Current Pet3 Breed |
Mix |
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Current Pet3 Sex |
1 Female, 2 Males |
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Current Pet3 Age |
9, 5, 5 |
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Current Pet3 Spayed Neutered |
Spayed & Neuterd |
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Current Pet3 Where Kept |
Inside |
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Current Pet4 Type |
Tortoise |
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Current Pet4 Breed |
African Sulcata |
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Current Pet4 Sex |
Male |
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Current Pet4 Age |
10 to 15 years |
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Current Pet4 Spayed Neutered |
No |
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Current Pet4 Where Kept |
Outside |
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Past Pets |
Yes |
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Past Pet1 Type |
Dog |
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Past Pet1 Breed |
Great Dane |
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Past Pet1 Age |
9 years old |
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Past Pet1 Spayed Neutered |
Spayed |
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Past Pet1 What Happened |
Stroke |
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Past Pet2 Type |
Dog |
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Past Pet2 Breed |
Great Dane |
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Past Pet2 Age |
9 years |
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Past Pet2 Spayed Neutered |
Neutered |
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Past Pet2 What Happened |
PTS - Spine Issues |
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Past Pet3 Type |
Many other Dogs & Cats |
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Past Pet3 Breed |
fostered & owned |
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Past Pet3 Age |
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Past Pet3 Spayed Neutered |
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Past Pet3 What Happened |
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Past Pet4 Type |
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Past Pet4 Breed |
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Past Pet4 Age |
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Past Pet4 Spayed Neutered |
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Past Pet4 What Happened |
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All Pets Vaccinated |
Yes |
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Familiar With Heartworm |
Yes |
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All Dogs Heartworm Protected |
Yes |
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Ever Relinquish Pet |
No |
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DogsOnly Fenced Yard |
Yes |
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DogsOnly Fence Type |
Block Wall |
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DogsOnly Fence Height |
6 feet |
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DogsOnly Aware Of House Training |
Yes |
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DogsOnly House Trained Before |
Yes |
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DogsOnly House Training Technique |
Watch & Get outside, then
praise |
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DogsOnly Aware Of Laws |
Yes |
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DogsOnly What If Behavior Issues |
Watch, Catch, & Correct
positively |
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DogsOnly Crate Train |
Yes |
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DogsOnly How Confined To Yard |
Stays indoors or within fenced
yard |
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CatsOnly Litterbox Trained |
Please select one |
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CatsOnly Indoor Outdoor |
Please select one |
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CatsOnly Declaw |
Please select one |
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CatsOnly Current Dogs Exposed To
Cats |
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Additional Comments |
This is a test application |
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AGREE TO TERMS CONDITIONS |
YES |
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Thank you for contacting us! |
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Time of Submission |
Wednesday 19th June 2013, 11:55 AM |
