Vintage

Thank you for your interest in adopting a rescued pet. Please fill out complete the following questionaire. All information is treated as confidential. If some of the questions seem intrusive, please understand that we are dedicated to facilitating successful, permanent matches between our rescued animals and the families who commit to them as a new family member. Submission of this application does not guarantee approval. An incomplete application is reason for refusal. Processing time may take two weeks, but we try to get the adoption completed as quickly as possible.

Important!!!   Please make sure to fill out all fields and the security field at the bottom.  If you do not do this correctly, it will reset, and you will have to submit again.  This will also change your email information that you entered previously.   You will have to re-enter your email information if you get such an error before you resubmit. So, please take your time and fill out the form completely.

Name of animal for which you are applying
Date of application
Breed
Color
Markings
How did you hear about us?
Your Name
Your Spouse's Name
Street Address
Apt. or Suite
City
State
Zip Code
Your Phone Number
Second or Cell Phone Number
Best Time to Call
Email Address
Second Email Address
Your Place Of Employment
Your Spouse's Place Of Employment
Number of men in household?
Number of women in household?
Number of children in household?
Ages of Children
Any health conditions which will prevent caring for your pet?
Length of time at current address
Do you expect to move in the near future?	YesNO
What type of home do you have?	HouseApartment/CondoFarmStudent HousingOther
What is your housing status?	OwnRentLive with parents Live with relative Live with friend
If renting, do you have landlord's permission for this pet?	YesNoN/A
If yes to landlord permission, provide name and phone number.
Do you have a yard?	YesNo
Do you have a fence?	Yes No
If you have a fence, how high is it and what material?		In this box, please indicate the height of the fence, and the material of the fence (i.e. chain link, wood, steel, etc.)
Do you plan to use any of the following?	Outside KennelRunnerChainTie LineDog House
Where will the dog sleep?
Where will the pet be during the day?
How many hours will the dog be alone each day?
What will you do with the pet if you move?
What will you do with the pet while on vacation?
What will you do if you are unable to care for the pet?
Who will be primarily responsible for the pet?
How will you discipline your pet?
What makes you a good pet owner?
Have you ever given up a pet?	YesNo
If you have given up a pet, please explain why.
How many pets do you currently own?
Describe your last pet, how long ago, and what happened to it.
Do you currently have a vet?	YesNo
If you have a vet, do you give Little Victories to check vet reference?	Yes No
Message:
If yes to reference, give vet's name and number.
If yes to reference, give vet's phone number.
If you currently own a pet, please answer the questions to the right of the box.		Type (dog,cat,bird, rabbit, etc.), Breed, Age, Gender, if Neutered/Spayed, If kept indoors or outdoors, if shots are up to date, and if on heartworm preventive.
If you currently own a pet, please answer the questions to the right of the box.		Type (dog,cat,bird, rabbit, etc.), Breed, Age, Gender, if Neutered/Spayed, If kept indoors or outdoors, if shots are up to date, and if on heartworm preventive.
If you currently own a pet, please answer the questions to the right of the box.		Type (dog,cat,bird, rabbit, etc.), Breed, Age, Gender, if Neutered/Spayed, If kept indoors or outdoors, if shots are up to date, and if on heartworm preventive.
If you currently own a pet, please answer the questions to the right of the box.		Type (dog,cat,bird, rabbit, etc.), Breed, Age, Gender, if Neutered/Spayed, If kept indoors or outdoors, if shots are up to date, and if on heartworm preventive.
Please enter the dark letters in the box in order for security and for spam prevention. *