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Rescue Pre-Screening and Application

 

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Rescuer's Information

Name: 
Address
City/State:
Zip Code:
Home Phone:
Work Phone: Ext.
Email Address:
Age:
Part One
Marital Status:
If SINGLE: Do you
Live alone? Yes No
Live with family? Yes No
Do you work? Yes No
What hours?
If MARRIED: Do you
Work? Yes No
What hours?
How many children are in the home?
Ages of children:
Who will be responsible for your sugar gliders? Other:
Part Two
Your residence is:
Residence is a/an:
If renting, does your lease allow for pets? Yes No
Are you moving? Yes No
If so, when?
Part Three
Do you have or have you had a pet/pets?
If NOW:
Do you breed? Yes No  

If yes, USDA License # :
How long have you had pets?
Where did you get your pet(s) from?
If BEFORE:
Did you breed? Yes No
How long did you have a pet(s)?
Where is the pet now?
Have you ever adopted or applied for adoption from here before? Yes No
Part Four
Your occupation:
Business Phone: Ext.
Company:
Supervisor's Name:
Part Five
Veterinarian
Address
Phone:
Please make sure to include a recommendation letter from your vet!
Reference 1:
Name:
Address:
City/State:
Zip Code:
Phone:
Reference 2:
Name:
Address:
City/State:
Zip Code:
Phone:
Comments:

   

 

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