EmailMe Form - ROFF Adoption Application

Name *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Cell Phone

### - ### - ####

Email

Date of Birth *

MM / DD / YYYY

ROFF animal you wish to give a forever home to... *

Your place of employment

	Name	Age
Name and ages of all people who reside in your household

Does anyone in your house have pet allergies?

YES

NO

How long have you been at your current residence?

5 or less years

5 - 10 years

> 10 years

Do you own or rent your home? *

OWN

RENT

	Name	Phone
If you rent, please list the landlords name and contact number

Do you have any other animals in your home right now?

YES

NO

Have you had a pet previously?

YES

NO

Have you ever surrendered a pet to another party? *

YES

NO

If yes, why?

How long will the animal be alone during the day?

6 or less hours

6 - 12 hours

> 12 hours

Where will they spend their day?

Where will the dog be when you are traveling?

Where will they sleep?

Have you ever applied to another rescue or shelter and been declined?

YES

NO

If yes, why?

What type of home do you live in?

Please describe your activity level of your household.

No activity

Moderate activity

Very active

Do you have time to provide adequate love and attention to this animal?

YES

NO

Have you ever lost a pet to an accident?

YES

NO

Do you have a fenced in yard?

YES

NO

Why do you want to adopt a pet?

Would you object to a background check?

YES

NO

Vet Reference

Vet Phone

### - ### - ####

	Name	Phone
Please list 3 personal references including contact numbers

Your Signature
(Please type in your name) *

With this "signature", I understand that I am not guaranteed a pet and that I give permission to a R.O.F.F. representative to verify that all information given in this application is true and correct. I also understand that if I cannot care for the cat, dog or bird, I must return it to ROFF and a refund will be made at the discretion of the ROFF Board Of Directors.