Adoption Application Pet You're Interested in Adopting Name(Required) First Last Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) Are you over 18 years old?(Required) Yes No Do you own or rent the home you live in?(Required) Own Rent Are there children in your household? Yes No Number of children in your household and their ages(Required)Which most accurately describes your normal day?(Required) Home all day Out part time Gone 7 - 10 hours per day Other If you rent, are animals allowed? Any restrictions on type of animals? (breed, weight, etc.) Do you have a yard?(Required) Yes No Is your yard fenced?(Required) Yes No N/A Indicate how many pets are currently living with you (include breed) *(Required) Are your pets ...(Required) Indoor only? Outdoor only? Both? N/A Are your pets current on their vaccinations?(Required) Yes No N/A Are all of your pets spayed/neutered?(Required) Yes No N/A If no, please explain. What type of heartworm prevention is your dog on?(Required) Name of your veterinarian *(Required) Any pet you adopt needs to get along with:(Required) Dogs Cats Kids Other How will your pet get exercise?(Required) Where will the pet be kept during the daytime?(Required) Loose indoors Loose outdoors Fenced yard Tied outside Basement Outdoor pen Crate or carrier Garage Closed in a room Where will the pet be kept during the night?(Required) Loose indoors Loose outdoors Fenced yard Tied outside Basement Outdoor pen Crate or carrier Garage Closed in a room Other I agree that until this agreement is signed by a TAPS Representative the pet belongs to TAPS and can request for the pet to be returned to them at any time.(Required) Yes I agree to provide a TAPS representative access to all parts of my home and property for a home inspection before my application is approved.(Required) Yes If at any point I become unable to keep my pet he/she will be returned to The Arkansas Pet Savers.(Required) Yes I agree to give my pet heartworm prevention according to the brand chosen and agree to routine vet visits to ensure my pet's health.(Required) Yes I agree that if I refuse or fail to comply with any provision of this agreement, TAPS has the right to terminate this agreement and also has the right to the immediate surrender and return of my animal(s). I further consent to provide TAPS access to my premises if necessary to facilitate the return.(Required) Yes I have read this application and agreement in its entirety, and I agree that all statements and agreements contained in this document are made by me and are truthful, under penalty of perjury under the law of the state of Arkansas.(Required) Yes Electronic signature(Required) Signed on this date(Required) MM slash DD slash YYYY Share this:FacebookLinkedInTwitterPocket
