Skip to content

About Us
Donate
Adopt
Contact
In The News

About Us
Donate
Adopt
Contact
In The News

Stay Connected

Facebook Instagram

Adoption Application

Please enable JavaScript in your browser to complete this form.

Personal Information

Name *

First

Last

Age *

Email *

Daytime Phone Number *

Evening Phone Number

Address *

Address Line 1

Address Line 2

City

State

Zip Code

How Long Have You Lived At This Address? *

Adoption Information

Are You Adopting For Yourself Or Someone Else? *

What Kind Of Pet Are You Interested In? *

What Type Of Cat Are You Interested In? (Select All That Apply) *

Male
Kitten (Under 1 year old)
Short Hair
Female
Adult
Long Hair

What Type Of Dog Are You Interested In? (Select All That Apply) *

Male
Puppy (Under 1 year old)
Short Hair
Female
Adult
Long Hair

Describe Any Other Details Of The Animal Your Are Looking For

If You Are Interested In A Specific Pet, Let Us Know Who It Is

Have You Had Companion Pets Before? *

Of Those Companion Animals You Still Care For, Please Provide The Following Information:

Please list the name, sex, breed, age, if they are spayed/neutered, the amount of time in your care, if they live indoor or outdoor, and how did you get the pet for EACH of your pets.

Are Your Pets Current On Vaccinations? *

Have They Been Tested For Feline Leukemia? *

Have They Been Tested For FIV? *

Are They Declawed? *

Reason You Would Like To Get A Cat? *

Other:

Will They Adjust To A New Cat In The House? *

What Precautions Would You Take To Properly Introduce A New Cat Into Your Home If You Have Other Animals?

Under What Circumstances Would You Have The Cat Declawed?

Are you aware of the potential side effects of declawing a cat? *

Have They Been Tested For Heartworm? *

Are They On Preventative Heartworm Medication? *

Reason You Would Like To Get A Dog: *

Will Your Pets Adjust To A New Dog In The House? *

What Precautions Would You Take To Properly Introduce A New Dog Into Your Home If You Have Other Animals?

What Will You do If Your New Pet Does Not Get Along With Your Present Companion Animals?

What Happened To The Pets You No Longer Have?

Have You Ever Turned In An Animal To A Shelter *

Please Explain

Have You Ever Had A Pet Euthanized? *

Please Explain

If A Disciplinary Or Behavior Problem Arises, What Steps Will You Take To Work On It? *

Please Explain

Household Information

How Many Adults Are In Your Family? *

How Many Children Are In Your Family? *

If Yes, What Are The Children's Ages?

Does Any Member Of Your Household Have Allergy To Cats? *

Does Any Member Of Your Household Have Allergy To Dogs? *

Do You Have A Fenced In Yard? *

What Type Of Fence?

Other:

How Tall Is Your Fence?

Does The Fence Fully Enclose The Yard? *

If You Do Not Have A Fenced Yard, How Will Your Dog Be Let Out?

Leashed Walked
Trained To Stay In Yard
Tied Out
Kenneled
Other

Check All That Apply

Other:

Where Will Your Dog Sleep? *

When You're Not Home Where Will The Dog Be Kept *

Crate
Run Of The House
Back Yard
Kennel
Access To Doggie Door
Dog House
Garage
Other

Check All That Apply

Other:

What Type Of Place Do You Live? *

Other:

Do You Rent Or Own Your Home?

Does Anyone In Your Household Smoke? *

Are Companion Animals Allowed? *

If You Rent, May We Contact The Owner To Obtain Permission For This Pet To Live In Your Home? *

Building Owner's Name

First

Last

Building Owner's Phone

Do You Have Plans Of Moving In The Near Future? *

If Yes, What Will You Do With Your Pet? *

Do You Have Screens On Your Windows? *

Do You Have A Cat/Dog Door? *

If Yes, Where Does The Cat/Dog Door Lead To? *

Occupation Information

What Is Your Current Occupation? *

Name Of Employer? *

Does Your Job Request Extensive Travel? *

If yes, who will care for your animal when you travel?

Will Anyone Be Home While You Work? *

If no, how many hours will the pet be left unattended?

Where Will Your Pet Live? *

Explain.

When No One Is Home, Where Will The Pet Stay? * *

Explain.

Veterinary Information

Name Of Veterinarian *

Phone Of Veterinarian *

Address Of Veterinarian

Address Line 1

Address Line 2

City

State

Zip Code

Will You Keep Your Pet Up-To-Date On Vaccinations? *

What Arrangements Will You Make For The Care Of Your Pet In Case Of An Emergency, Or If You Become Unable To Care For Him/Her? *

Have You Applied To Pumpkin Patch Before To Adopt An Animal? *

Have You Ever Had An Application Rejected For Adoption Of An Animal From A Rescue/Animal Control Facility? *

Please Explain *

Are You Aware That Cats Can Live 15 To 20 Years And Are You Willing To Take Responsibility For This Cat For The Next 10 To 20 Years? *

Are You Aware That Dogs Can Live 15 To 20 Years And Are You Willing To Take Responsibility For This Cat For The Next 10 To 20 Years? *

Are You Familiar With Your Local Animal Control Laws? *

Where Will The Cat Live? *

Where Will The Dog Live? *

Are you willing to sign the legal pet adoption papers? *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Additional Comments From Applicant

Interest Level: *

Disclosure *

By checking this box, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact, or lack of information, may result in Pumpkin Patch Pet Rescue refusing adoption privileges to me/us. If my/our request for adoption is approved and later Pumpkin Patch Pet Rescue discovers the above information is not true or correct, Pumpkin Patch Pet Rescue reserves the right to remove the adopted animal from my home. This pet will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian. If I can no longer keep this pet for any reason I agree to return it to Pumpkin Patch Pet Rescue.

We focus on the rescue, rehabilitation, and fostering of special needs animals with express purpose of placing them into forever homes.

Facebook Instagram

Term of Services
Privacy Policy
Cookie Policy