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