King's Harvest Pet Rescue Adoption Application

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pet to be adopted {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Pet's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Your Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Maiden Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Cell # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Home # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Work # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Place of Employment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Work Hours {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name of Spouse/Roomate(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age(s) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Spouse/Roommate Place of Employment {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Your current living arrangements: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

How long have you been at your current address? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Would you be interested in another pet if your choice becomes unavailable? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If you rent or live in a condo, we must confirm that pets are allowed. Please supply contact information for your apartment or condo/townhome below.

Landlord's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Landlord's Phone # {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name of Apartment Complex or Condo Association {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If you ever move, will you take this pet with you? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please list all people living at this address, known allergies, and ages of children.

Person {binding ItemNumber}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Allergies {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age (if child) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please list all of the pets you have had in your home within the last 4 years and currently:

Pet {binding ItemNumber}

Type/Breed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Age {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Sex {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Spay / Neuter {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Currently in home? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Why is pet no longer in home? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Years owned {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Current or last used Veterinarian {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Current or last used Clinic {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Vet/Clinic Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you intend to de-claw the cat you adopt? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you have de-clawed cats at your home now? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Will your cat be allowed to go outside? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Do you have a fully fenced-in yard with no gaps? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Are you looking for an inside or outside pet? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Approzimately how many hours will your pet be alone each day? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Where will your pet stay during the day? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Where will your pet stay in the evening? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Under what circumstances would you consider giving up your pet? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Most of the time we have limited knowledge of the pets that are brought to our shelter. Therefore, we cannot guarantee the health, behavior, temperament, age or breed of any pet adopted from King’s Harvest Pet Rescue. If you are unable to keep this pet for any reason during its lifetime, we require that you contact us.

KING’S HARVEST PET RESCUE - 563-386-3117

By signing below, I am attesting to the truthfulness of my answers. Falsification or misrepresentation of the above information will result in rejection of this application or possible removal of the pet from my home. King’s Harvest Pet Rescue reserves the right to refuse any applicant.

Signature {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Upload a copy of your ID {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}