Pet Adoption Application Bird Adoption Application I am fully aware that I will be adopting a living creature and as such CARE is unable to guarantee the health of the adoptee. If the adoptee becomes ill or gets injured I certify that I am financially and emotionally prepared to treat my new pet at my own expense.By Signing Below, I Acknowledge I Have Read and Understand CARE's Adoption Policies.(Required) Date signed(Required) MM slash DD slash YYYY Center for Animal Rehabilitation & Education 501 (c)(3) Non-Profit Tax-Exempt It is our goal to place each adoptee in the most suitable environment. If the adoptee you apply for is not appropriate for your home environment and/or level of expertise, you will be directed to a more appropriate option.First Name(Required) Middle Initial(Required) Last Name(Required) Date of Birth(Required) Month Day Year Contact InformationE-Mail Address(Required) Primary Phone(Required)Other PhoneCurrent Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip How Many Years Have You Lived at the Above Address?Your current address is a... Single Family Condo Apartment Duplex Mobile Home Other Do you own or rent your home? I Own the Above Address I Rent the Above Address Other Please Provide Landlord or Condo Assn. Name & Phone # Enter N/A if not applicableIf You've Lived at the Above Address Less Than 5 Years, Please Enter Your Previous AddressPrevious Address City, State, Zip List Your Current Occupation, Employers Name and Phone Number along with your Daily Work Hours(Required)How Did You Hear About CARE? I Want to Adopt Bird-Very Large(Macaw,Cockatoo) Bird-Large(Amazon, African Grey) Bird-Smaller Other Adoptee Description (Please Be as Specific as Possible: Species, Age, Name From PetFinder)Why Do You Want the Adoptee or Type of Adoptee Specified Above? If This is a Special Needs Adoptee Please Describe Your Experience With a Special Needs Pet.There Will Be a Period of Adjustment When Your New Bird Comes to Live With You. E.g. Birds May Scream. How Will You Handle This and How Will You Prepare Your Home?Where Will Your New Pet Stay/Be Cared for While You Are Out of Town? Pets You Currently Own.Include Name, Species, Breed, Age, Gender, If Sterilized and Date of Last Vet Visit (Current Vaccinations, if Applicable). If None, Enter "None."Pets You Previously Owned.Include Breed, Gender, How Long You Had Each One, Why You No Longer Have Each One.Please contact your veterinarian(s) and give them permission to discuss your pets with us (CARE). We will attempt to contact your veterinarian(s) two times over the next three business days. If they are unable to discuss your pets with us on the second call, this application will be discarded.Veterinarian's Name, Specialty & Phone NumberVet 1 Vet 2 What Do You Feed Each of Your Current Pets?What Size Cage Are Your Current Pets in?Please Respond in Length x Width x Height Format Number of Hours Your Bird(s) Are Allowed Out of Their Cage(s) Each Day? Cage Dimensions for New Bird Please List the Full Names (Including Middle Initial), Dates of Birth, and Relationships to You of All Others Living in Your Home.(Required)Does anyone in the home smoke?(Required) Yes No (if Yes, Where?) Does Anyone in the Home Have Dust or Dander Allergies? Yes No Hours You Are Away From Home Each Day for Work, School, Etc. Who Will Take Care of the Adoptee if Something Happens to You? I certify that I am over the age of 18 and the information I have given is true and correct. I understand that any misrepresentation made on this application may result in my loss of privilege to adopt from CARE. I further acknowledge that CARE makes no warranty as to age, health, breed, habits and/or disposition of birds and animals, and I completely and fully release CARE from any liability for any injury or damage any bird or animal may inflict upon any person (including children) while handling a bird or animal at our facility, or in your home. If, after you submit your application, you do not hear from us within 24 hours, please contact us at care4rehab@gmail.comEmailThis field is for validation purposes and should be left unchanged. Bird Application Dog Adoption Application Statement of Understanding: I am fully aware that I will be adopting a living creature and as such CARE is unable to guarantee the health of the adoptee. If the adoptee becomes ill or gets injured, I certify that I am financially and emotionally prepared to treat my new pet at my own expense.By Signing Below, I Acknowledge I Have Read and Understand CARE's Adoption Policies.(Required) Date signed(Required) MM slash DD slash YYYY Center for Animal Rehabilitation & Education 501 (c)(3) Non-Profit Tax-Exempt It is our goal to place each adoptee in the most suitable environment. If the adoptee you apply for is not appropriate for your home environment and/or level of expertise, you will be directed to a more appropriate option. All dog adopters must live within 200 miles of CARE.First Name(Required) Middle Initial(Required) Last Name(Required) Date of Birth(Required) Month Day Year Contact InformationE-Mail Address(Required) Primary Phone(Required)Other PhoneCurrent Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip How Many Years Have You Lived at the Above Address?Your current address is a Single Family Condo Apartment Duplex Mobile Home Other Your current address is a I Rent the Above Address I Own the Above Address Other Please Provide Landlord or Condo Assn. Name & Phone #(Required) Enter N/A if not applicableIf You've Lived at the Above Address Less Than 5 Years, Please Enter Your Previous AddressPrevious Address City, State, Zip List Your Current Occupation, Employers Name and Phone Number and Your Daily Work Hours(Required)How Did You Hear About CARE? Interested in Which Adoptee(s)? (Please Be as Specific as Possible: Breed, Age, Name From PetFinder)Why Do You Want the Adoptee Specified Above? If This is a Special Needs Adoptee Please Describe Your Experience With a Special Needs Pet.There Will Be a Period of Adjustment When Your New Pet Comes to Live With You. E.g. Dogs May Have Accidents. How Will You Handle This and How Will You Prepare Your Home?Where Will Your New Pet Stay/Be Cared for While You Are Out of Town? Pets You Currently Own.Include Name, Species, Breed, Age, Gender, If Sterilized and Date of Last Vet Visit (Current Vaccinations, if Applicable). If None, Enter "None."Pets You Previously Owned.Include Species, Breed, Gender, How Long You Had Each One, Why You No Longer Have Each One.Please contact your veterinarian(s) and give them permission to discuss your pets with us (CARE). We will attempt to contact your veterinarian(s) two times over the next three business days. If they are unable to discuss your pets with us on the second call, this application will be discarded.Veterinarian's Name, Specialty & Phone NumberVet 1 Vet 2 What Do You Feed Each of Your Current Pets?Do You Have a Fenced In Yard? I have a fenced in yard I do NOT have a fenced in yard If No Fenced in Yard, How Will Your Dog Be Exercised?Where Will Your Dog Sleep? Groomer's Name & Phone Number Please List the Full Names (Including Middle Initial), Dates of Birth, and Relationships to You of All Others Living in Your Home.(Required)Does anyone in the home smoke?(Required) Yes No (if Yes, Where?) Does Anyone in the Home Have Dust or Dander Allergies? Yes No Hours You Are Away From Home Each Day for Work, School, Etc. Who Will Take Care of the Adoptee if Something Happens to You? I certify that I am over the age of 18 and the information I have given is true and correct. I understand that any misrepresentation made on this application may result in my loss of privilege to adopt from CARE. I further acknowledge that CARE makes no warranty as to age, health, breed, habits and/or disposition of birds and animals, and I completely and fully release CARE from any liability for any injury or damage any bird or animal may inflict upon any person (including children) while handling a bird or animal at our facility, or in your home. If, after you submit your application, you do not hear from us within 24 hours, please contact us at care4rehab@gmail.comCommentsThis field is for validation purposes and should be left unchanged. Dog Adoption Application Small Animal Adoption Application I am fully aware that I will be adopting a living creature and as such CARE is unable to guarantee the health of the adoptee. If the adoptee becomes ill or gets injured I certify that I am financially and emotionally prepared to treat my new pet at my own expense.By Signing Below, I Acknowledge I Have Read and Understand CARE's Adoption Policies.(Required) Date signed(Required) MM slash DD slash YYYY Center for Animal Rehabilitation & Education 501 (c)(3) Non-Profit Tax-Exempt It is our goal to place each adoptee in the most suitable environment. If the adoptee you apply for is not appropriate for your home environment and/or level of expertise, you will be directed to a more appropriate option.First Name(Required) Middle Initial(Required) Middle name or initial of applicant. If no middle name, enter N/ALast Name(Required) Date of Birth(Required) Month Day Year Contact InformationE-Mail Address(Required) Primary Phone(Required)Other PhoneCurrent Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip How Many Years Have You Lived at the Above Address?Your current address is a... Single Family Condo Apartment Duplex Mobile Home Other Do you own or rent your home? I Own the Above Address I Rent the Above Address Other Please Provide Landlord or Condo Assn. Name & Phone #(Required) Enter N/A if not applicableIf You've Lived at the Above Address Less Than 5 Years, Please Enter Your Previous AddressPrevious Address City, State, Zip List Your Current Occupation, Employers Name and Phone Number along with your Daily Work Hours(Required)How Did You Hear About CARE? I Want to Adopt Guinea pig Gerbil Reptile Other Adoptee Description (Please Be as Specific as Possible: Species, Age, Name From PetFinder)Why Do You Want the Adoptee or Type of Adoptee Specified Above? If This is a Special Needs Adoptee Please Describe Your Experience With a Special Needs Pet.There Will Be a Period of Adjustment When Your New Pet Comes to Live With You. E.g. Rodents may hide. How Will You Handle This and How Will You Prepare Your Home?Where Will Your New Pet Stay/Be Cared for While You Are Out of Town? Pets You Currently Own.Include Name, Species, Breed, Age, Gender, If Sterilized and Date of Last Vet Visit (Current Vaccinations, if Applicable). If None, Enter "None."Pets You Previously Owned.Include Species, Breed, Gender, How Long You Had Each One, Why You No Longer Have Each One.Please contact your veterinarian(s) and give them permission to discuss your pets with us (CARE). We will attempt to contact your veterinarian(s) two times over the next three business days. If they are unable to discuss your pets with us on the second call, this application will be discarded.Veterinarian's Name, Specialty & Phone NumberVet 1 Vet 2 What Do You Feed Each of Your Current Pets?What Size Cage Are Your Current Pets in?Please Respond in Length x Width x Height Format Number of Hours Your Pet(s) Are Allowed Out of Their Cage(s) Each Day? Cage Dimensions for New Pet Please List the Full Names (Including Middle Initial), Dates of Birth, and Relationships to You of All Others Living in Your Home.(Required)Does anyone in the home smoke?(Required) Yes No (if Yes, Where?) Does Anyone in the Home Have Dust or Dander Allergies? Yes No Does Anyone in the Home Have Allergies to Timothy Grass Hay? Yes No Hours You Are Away From Home Each Day for Work, School, Etc. Who Will Take Care of the Adoptee if Something Happens to You? I certify that I am over the age of 18 and the information I have given is true and correct. I understand that any misrepresentation made on this application may result in my loss of privilege to adopt from CARE. I further acknowledge that CARE makes no warranty as to age, health, breed, habits and/or disposition of birds and animals, and I completely and fully release CARE from any liability for any injury or damage any bird or animal may inflict upon any person (including children) while handling a bird or animal at our facility, or in your home. If, after you submit your application, you do not hear from us within 24 hours, please contact us at care4rehab@gmail.comCommentsThis field is for validation purposes and should be left unchanged. Small Animal Application Want To Help? Dog Fostering Application Name(Required) First Name Middle Initial Last Name Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number(Required)Email(Required) Date of Birth(Required) MM slash DD slash YYYY List Your Current Occupation, Employers Name, Phone Number, and Your Daily Work Hours.(Required)Do You Own or Rent Your Home?(Required) Own Rent Type Single Family Apartment Condo Townhouse If Condo, Condo Association Phone Number and EmailPhone NumberEmail If Renting, Landlord's Name, Phone Number, and E-mailName PhoneEmail What is the Pet Policy Where You Live?List all pets currently in household. Include: Name, breed, sex, age, and if sterilized (neutered, spayed). If none, please enter "none"If Pet(s) Are Not Sterilized, Do You Plan on Doing So in the Future?(Required) Yes No N/A If No, Why?Are Pet(s) Vaccines Current?(Required) Yes No N/A Please contact your veterinarian(s) and give them permission to discuss your pets with us (CARE). We will attempt to contact your veterinarian(s) two times over the next three business days. If they are unable to discuss your pets with us on the second call, this application will be discarded.Name of Veterinarian/ClinicName Phone NumberAddress Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code List Any Children Currently Living in the Household or Who Frequently Visit Child's Name AgeChild's Name AgeChild's Name AgeChild's Name AgeChild's Name AgeList All Adults Currently Living in the Household Along With Their Relationship to You and Date of BirthI Would Like to Foster Adult Dog Young Adult Dog Injured Dog Hospice Dog Special Needs Dog (Shy/Timid, Lacking Training, or in Need of Medical Care) Are You Willing to Foster Dogs With Kennel Cough or Other Respiratory Infections? Yes No Please List Previous Experience With Caring for a Special Needs DogOn Average How Many Hours Per Day Would the Dog Be Alone?(Required) When You Are Not Home Where Will the Foster Dog Be Kept?(Required)Do You Have a Spare Room That Can Be Used to Confine a Foster Dog? Yes No What Length of Time Are You Willing to Commit to Fostering? 1 Month 2 Month Until the Dog is Adopted Are You Interested in Fostering to Adopt? Yes No Have You Ever Surrendered a Pet?(Required) Yes No If Yes, Why?Do You Have a Fenced in Backyard?(Required) Yes No If No, How Will the Dog Be Exercised?Where Will the Foster Dog Sleep?(Required)Best Time of Day to Be Reached by Phone Hours : Minutes AM PM AM/PM Any Additional Information About Yourself, Why You Want to Foster, or Anything Else That You Would Like to Share.I certify that all the information given above is accurate to the best of my ability and give CARE authorization to verify any information. I certify that the information I have given is true and correct. I understand that any misrepresentation of this application may result in my losing the privilege to foster a pet from CARE. I understand that CARE has the right to deny my request to foster a pet, and I authorize investigation of all statements in this application. I certify that all the information given above is accurate to the best of my ability and give CARE authorization to verify any information. I certify that the information I have given is true and correct. I understand that any misrepresentation of this application may result in my losing the privilege to foster a pet from CARE. I understand that CARE has the right to deny my request to foster a pet, and I authorize investigation of all statements in this application. Applicant Signature(Required)Date(Required) MM slash DD slash YYYY Waiver of Liability In consideration of CARE accepting my application for participation in its foster care program, I agree to release and hold harmless CARE from and against any and all loss, damage, claims, liability, costs and expenses, of any nature whatsoever, including without limitation, attorney’s fees and disbursements and do further agree to indemnify CARE for any of the foregoing asserted by any third party, including, but not limited to, other individuals residing at my home, to the extent that any of the foregoing arise from or are occasioned by my participation in CARE foster care program. I understand there are certain risks in handling animals (may bite, scratch or injure), and I further release CARE from any liability from future injuries. I agree to allow CARE to photograph or use for publicity or publications volunteer’s participation in the foster care program. I agree and understand that when I care for a CARE dog, in my home, I am doing strictly as a volunteer and in the spirit of volunteerism. Thus, I will not expect to make claim for wages in return for my services. Applicant Signature(Required)Date(Required) MM slash DD slash YYYY If, after you submit your application, you do not hear from us within 24 hours, please contact us at care4rehab@gmail.comNameThis field is for validation purposes and should be left unchanged. Dog Fostering Application Volunteer Application Name(Required) First Name Middle Init. Last Name Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Date of Birth(Required) Month Day Year Phone NumbersHomeCell(Required)WorkE-mail Address(Required) Preferred Method of Contact Home Cell Work E-mail For Applicants Under 18** Before volunteers under 18 can start, their parent/guardian must accompany them to CARE and sign a waiver **Parent/Guardian Name Contact PhoneHave You Had Any Previous Experience (Volunteer and/or Employee) With Any Rescue Group or Animal Shelter?Please Tell Us Why You Would Like to Volunteer at CARE.Are You Fulfilling Community Service Hours?(Required) Yes No Are You Fulfilling Academic Volunteer Requirements?(Required) Yes No List Your Pets(Name, Age, Species, Breed, Spayed/Neutered, Behavior Issues)Days/Times AvailablePlease list all days and AM/PM when you would be availableMedical Conditions/Physical RestrictionsAllergiesPlease list all food and environmental allergiesDate of Last Tetanus MM slash DD slash YYYY Emergency ContactName (First/Middle/Last)(Required) Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell Phone(Required)Work PhoneINSURANCE WAIVER The undersigned Volunteer and the Center for Animal Rehabilitation & Education, Inc. (CARE, Inc.) enter into the following binding Agreement: Volunteer understands that CARE, Inc. makes no warranty as to age, health, breed, habits and/or any remote location could inflict upon any person or property, and for any illness of the animal or for the transmittal of any illness or parasite to any other pet or person. Volunteer further indemnifies and holds harmless CARE, Inc. for any actions, suits, fees and/or expenses (including actual attorney's fees) arising out of any injury from an animal on the premises of CARE, Inc. and/or any remote location.The Volunteer Name on This Application Indicates They Are at Least 16 Years Old. Yes No If, after you submit your application, you do not hear from us within 24 hours, please contact us at care4rehab@gmail.comCommentsThis field is for validation purposes and should be left unchanged. Volunteer Application
