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Adopt a Back Roads Rescue
Please complete this application for consideration for foster/adoption of any of our rescue animals. Adoption fees range from $150-250, depending on the needs of the animal (standard dog adoption fee is $200) and includes complete veterinary care. IF YOU CANNOT AFFORD THIS ADOPTION FEE, PLEASE DO NOT SUBMIT THIS APPLICATION. We pay all costs for all animals and if we didn't recoup SOME of these expenses then we could not continue our rescue work.
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Indicates required field
What pet(s) are you interested in?
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Name
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First
Last
Occupation
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Email
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Home Phone
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Cell Phone
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Do you text
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Yes
No
Address
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Line 1
Line 2
City
State
Zip Code
Country
How long have you lived at this address
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Family & Housing
How many adults are there in your family and what is their relationship to you?
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How many children are there in your family and what are their ages?
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What type of home do you live in?
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Single Family
Town Home
Apartment
Farm
Other
If you rent, please describe rules governing pets
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By providing this information you are allowing BRAR to contact your landlord
If you rent, what is your landlords name and contact information?
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Please advise your landlord that someone from our organization will be contacting them for verification that pets are allowed on premises
Please describe your household activity level
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Active
Noisy
Quiet
Average
Other
Does anyone in your family have a known allergy to animals?
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Yes
No
Other
Is everyone in agreement with the decision to adopt a pet?
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Yes
No
Other
Do you have time to provide adequate love, attention and exercise for the animal you wish to adopt?
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Yes
No
Other
Other Pets
What other pets do you have (specify type and number)?
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Are your current pets up to date on vaccinations, heartworm prevention, etc?
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Yes
No
Other
If you answered no to the previous question, please explain in detail:
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Are your current pets spayed or neutered? If not, please explain in depth your reasoning
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Have you ever surrendered a pet (to another person, animal shelter, etc)? If so, please explain in depth the circumstances surrounding the surrender
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Have you ever euthanized a pet for any reason besides old age? If yes, please explain:
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Have you ever lost a pet to an accident? If so, please explain
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How do you discipline your pets?
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Veterinarian Information
By providing us with this information you are allowing a representative from our organization to contact your vet. You will need to call your vet to authorize the release of information.
Do you have a regular veterinarian?
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Yes
No
Other
Veterinarian's Name and/or Clinic Name
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Veterinarian's Phone Number
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Include area code
About the Rescue you wish to adopt:
Desired Age
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Baby
Young Adult
Adult
Mature Adult
Senior
Desired Breed
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What breed would you not consider adopting?
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Desired Gender
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Neutered Male
Spayed Female
We do not adopt unaltered animals under any circumstance (unless our veterinarian advises against it for medical necessity)
Where will your adopted pet spend the day (describe)?
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Where will your adopted pet spend the night (describe)?
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How many hours per day will your adopted pet spend unsupervised (on average)?
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Who will have primary responsibility for your adopted pet's daily care?
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Who will have financial responsibility for your adopted pet?
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Do you agree to provide regular health care by a licensed veterinarian?
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Yes
No
Other
When/if your adopted pet goes outside, how will you contain them to protect from injury and danger?
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Do you agree to contact Back Roads Animal Rescue if you can no longer keep your adopted pet for any reason?
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Yes
No
Other
Are you willing to allow a representative from our organization visit your home by appointment?
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Yes
No
Other
Personal References
We ask for three personal references, at least one of them cannot be a relative
Name of First Reference
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First
Last
NOT a relative
Phone # of First Reference
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Email of First Reference
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Relationship to you:
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Friend
Neighbor
Co-Worker
Other
Name of Second Reference
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First
Last
Phone # of Second Reference
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Email of Second Reference
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Relationship to you:
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Friend
Relative
Neighbor
Other
Name of Third Reference
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First
Last
Phone # of Third Reference
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Email of Third Reference
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Relationship to you
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Friend
Neighbor
Relative
Other
If approved, we will contact you as soon as possible
We will ask you to sign an adoption agreement at the time of adoption
Submit
About
Surrender
Donate
Volunteer
Foster
Apply to Volunteer
Adopt
Adoption App
Blog
Contact
TNR
Be Involved
Fence Project
Forms
