REPTILE APPLICATION FORM
Date:_______________________________
Type of Pet Desired: Lizard r Snake r Frog r Turtle r Otherr __________
What is the reason for adopting this pet? Companion for other pet r For the children r Gift r Companionshipr Breeding r Classroom Use r Other r ______________
Your Name _______________________ Driver's License # _____________________
Street/ PO Box_____________________ Home Phone # _______________________
City _________________________ Zip Code ________ Work Phone # ____________
Type of Housing: Rent apartment r Rent House r Own House r Other __________
If you rent, what is your landlord's name? _____________________ Phone # ____________
Number of adults in household: ___ Number of children in household _______
Children's ages __________
Does anyone have allergies to animals? ____ If yes, what kind of animal allergy? __________
Who is your veterinarian? ____________________________ City ____________________
Please list reptiles/amphibians presently in your household.
Species Sex Age How long owned Where Kept
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
Please list reptiles/amphibians owned previously in the last 5 years.
Species Sex Age How long owned What happened to pet?
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
Have you ever owned the kind of pet you wish to adopt? ____ If yes, how long ago? ________
What happened to the pet? _____________________________________________________
Did the pet ever have offspring? _____ If yes, what did you do with the offspring? ___________
How will you house your pet? Loose in the yard? r Loose in the house r Cage r (Size dimensions High___ Wide___ Deep____)
Where will your pet be kept? Outside r In Garage r Covered outside area r In house r
Who will be responsible for your pet's care? ________________________________________
Are you familiar with this pet's needs for: Food/water ______ Heating/Lighting ______
Vet Care ______
Do you have a preference for breed, age, sex? _____________________________________
Signature ________________________________________ Date __________________
Comments: ____________________________________________________________
______________________________________________________________________
Pending ________________ Impound Check ______ Approved (Counselors Int.)___
This form is evaluated by Pets Are Us Rescue.
Our goal is to place our animals in the best home we feel possible. By signing this you agree for our rescue org. to
check on the conditions and living circumstances as we choose. All adoptive pets are not to be
bred or resold!
There is an adoption fee for all animals unless otherwise specified
If for some reason the animal does not work out in your home the animal is to be
returned to our rescue org. so we may find another suitable home. Adoption fees are a non-
refundable donation. Pets Are Us Rescue is a non-profit org. and
all fees collected are used to care for the animals in our care and the future animals soon to
be in our care. We survive solely on these donations and mostly the use of our own money for
animal care. There is no health guarantee on any animal adopted. Our promise to you is that we will
never knowingly adopt an ill or diseased animal. We try to find out all past information an the
animal but after all these are rescue animals and their past may be a mystery. We do our best to
ensure good health.
Please read carefully and understand all conditions associated with this adoption
application .
Signature:________________________________ Date:_____________________________
reptilesru@aol.com
If this pet is intended for classroom use, please answer the following:
Name of your school ______________________________________________________
City ______________________________________
Age/Grade of children ______________ Number of hours the school is open each day ____
Number of children ______________ Number of adults ______________________
Who will be the main guardian (responsible person) of this pet? _____________________
What care arrangements have been made for the pet during:
Weekends? _______________________________
Extended holidays? _________________________
What will happen to the pet at the end of the school year? _________________________
What kind of experience do you have with this type of pet? _____________________________
__________________________________________________________________________
Is this pet going to be part of a teaching unit you are planning? ______ If yes, how so? _______
___________________________________________________________________________
What is your main purpose in adopting this pet? ______________________________________
What will happen to this pet is his/her temperament is not suitable to a classroom setting? _____
__________________________________________________________________________
Please copy and paste into email. Send to volunteers email address listed on animal
