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fill in and return. Thank you!
| Another Chance Animal Rescue | 207-676-9330 |
| PO Box 552 37 Market Street | www.acanimalrescue.org |
| North Berwick, Maine 03906 | |
Name ____________________________________ DOB _________ Address
_____________________________
Spouse's name ___________________________________________ Mailing
address ______________________
Tel. no. (day) ________________ (evening) _________________ City
________________________________
State ___________ Zip
_________
Do you own or rent your home? _______; Landlord's name & no.
_______________________________________
How long have you lived there? _________________; Are you planning
to move? _________________________
No. of adults in home: ____; No. of children: ____; Ages:
___________; Does anyone in your family have allergies? _______________
Who is this dog for? You/family ___; Gift (for whom)
________________; Who will be responsible for the dog's care? ______________
Have you had a dog before? _____; What happened to it?
_____________________________________________________
Do you have any pets now? Dogs _____; Cats _____; Other
___________________________________________
Are/were they spayed/neutered? ______________; Regular health
checkups? _____________________________
Veterinary reference:
_______________________________________________________________________
How long will pet be alone during the average weekday? ________;
Where will pet stay when you are not home? __________________
How will the dog be confined to your property?
_________________________; Exercised? __________________________
What will you do with the dog if you go away?
________________________; If you move? _______________
If you can no longer keep the dog, what would you do with it?
______________________________
Describe the kind of dog/puppy you are
looking for (Preferred breed, color, age, etc.):
I certify that the above information is true and I authorize
Another Chance Animal Rescue to check my references.
Your signature______________________________________ Date________________________________
Office use:
ACAR representative _______________________________ Home check
required? _______; Landlord permission _________
References: Vet. ______; Personal __________________________
Approved ___; Denied ___ (Reason)
______________________________________________________________________________
"…Because Every
Animal Deserves Another Chance!"