Dog Adoption Application

Please list all of the members of your household date of birth, including yourself. Given names including middle initials.

Please list your current pets and their health status:

Please provide the following information about all the pets you have owned in the past 5 years of your adult life, who are no longer with you:

Who is your current or past veterinarian, which will have your record for previous/current pets? PLEASE inform them we will be calling to eliminate delays in processing your application

Please list three references (one family member only) that we may contact to discuss your animal care experience and dedication with:

By signing this application, if the unfortunate circumstance would arise that you can no longer care for the animal you have agreed to adopt, said animal must be returned to Perry County Animal Rescue. No surrender fee will be charged nor will a refund of any kind be given. This animal may under no circumstances be given or sold to another party. Further, your signature allows Perry County Animal Rescue to visit your home semiannually for at least the first two years after adopting the animal to ensure said animal is receiving proper care. PLEASE NOTE: Age, breed, training, temperament, health etc. are documented to the best of the Rescue’s knowledge and there are no guarantees. Be aware that you and all adults in the household may be subject to a background check. By submitting this form you confirm your electronic signature is accepted and that the act of signing electronically accepts this