Cat and Dog App

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CAT/DOG ADOPTION APPLICATION
CONTRACT

PIBBLE & MORE ANIMAL RESCUE
P.O. Box 863998
Ridgewood NY 11385

Phone: 347-613-2782
Email: Pibblesrus33@gmail.com

Please take time to accurately complete the application. Thank you.

Date:  _________2/29/12________                    Adopted:_________Cole________________
Description (breed, color ect..)_______Domestic long hair Black and white cat, medium__
Neutered/Spayed?_________Yes_________________ Age_________Baby__
If your dog/cats become injured, are you willing to pay at least $100 to $300 in medical costs?
__x_YES or ___NO
Would you agree to an unannounced visit and/ or phone call? __x_YES or ____NO
What is your main reason for wanting a pet?__I want an animal that I can love and provide a good home to.___

Name_________Barbara Chandler__________________

Name of Spouse___________Luis Vidal_______________________________

Address_________1725 Madison Street_____________________________

City___________Ridgewood________________State__NY_____Zip_11

385___

__________________

Daytime Phone #(   718   )__360-0928___

Evening Phone # (   718   )__600-3389__

Driver’s License#______________437100811_______________

Are you over   21 years of age? Yes___x__ No_____ If Yes, what is your age?___________32_____________

E-mail address______________________sexyb1212@aol.com__________

Residence: (check one) ____ House ___Condo _x__Apartment ___Hobby Farm ___Mobile Home

Do you Own or Rent? ____Own __x__Rent

If Rent, do you have permission from your landlord to adopt a cat/dog? Yes__x__ No____

Name of Landlord_________Berangere Champagne______________

Phone # (718 )___564-9053___

Do you have children under the age of 18 living in the household? Yes__x___ No_____

If yes, list their ages___2 m, 6 yrs, 9 yrs_________________

If you have children, what has been their exposure to cats/dog? None___ Some___ A lot__x__

Excluding children, spouse and applicant, list any... [continues]

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