Adoption Application

Please fill out the form below if you are interested in adopting a pet from 1 Life 2 Live Rescue.

To ensure the safety and best interest of the animals we have taken into our care, we ask that everyone who is interested in fostering or adopting an animal from this rescue fill out this application form. Please be aware that in doing so you are giving the volunteers of this organization the right to check your references by telephone and to come to your residence for a home visit. If you have any questions about our procedures or in filling out this form, help is available by contacting the rescue at the following email address: or telephone Debbie Stezar @ 570-341-1997

Thank you for considering rescuing an animal in need of a good home. The adoption of a life-long friend should not be impulsive, but rather a carefully made decision which will ensure a loving, lasting relationship. Please provide us with the following personal information:

Name of Animal *

Type of Animal *



E-mail Address: *
First Name *

Last Name *

Phone Number: *

Cell Number:

Street Address: *

Address Line 2:

City: *

State: *

Postal Code: *

Please provide the names and telephone numbers of at least 2 personal references (no relatives please). Please do not give the name of your veterinarian here as there will be another section of the application devoted to vet references. Please tell us how long you are acquainted with each personal reference.
Reference #1 (Please include phone #) *

Reference #2 (Please include phone #)*

Reference #3 (Required if a vet reference cannot be provided due to not owning an animal for some time)

How many adults reside in your household? Including yourself *

Please list the names and ages of all adults: *

Do all members of the household want a new pet? *


If you have children, please list names and ages:

Do any members of your family suffer from allergies? *


How many dogs live with you? *

How many cats live with you? *

How many other animals live with you? *

Please provide the following information for each pet: Please list Type (Dog, cat, etc.), age of pet, gender of pet, whether or not the animal if spayed or neutered (and if not, please state the reason why). Please tell us whether or not the pet is up-to-date on vaccinations (if not, why?) and whether or not you use Heartworm preventative on the pet.

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Pet #6

Name of Vet/Clinic (Please contact your vet asap to give permission for release of information if required) *

How long with this vet? *

Vet Phone Number *

Have you ever given up a pet? *


If yes, why?

What happened to the last pet you owned? *

Do you own your home? *


If no, please provide the name and telephone number of your landlord:

Landlord Name:

Landlord Phone Number:

Do you have a yard? *


If yes, how big is it?

Do you have a fence around your yard? *


Is your yard fully fenced? *


Type of fence

Height of fence

Do you have an outdoor pen/kennel? *



Is it covered?


Where will your pet be kept when you are not at home during the day? *

How long are your pets left alone on a normal day? Weekdays? Weekends? *

Where will your pet be kept when you are away for more than a day? *

Do you have a pet sitter? *


If yes, please give name

Where will your pet be kept at night? *

Are you willing to work with the animal if a behavioral problem should arise? *


Would you like a referral for Obedience Training? *


Please explain your reasons for wanting to adopt this animal: *

Are you familiar with crate training? *


Are you willing to use a crate for your new pet?


Preferences: (No need to answer these questions if the application is only for a particular animal):

Animal preference

Age preference for an animal you wish to adopt?

Breed or mix preference (if any):

Color preference


Activity preference:

Gender preference (all are neutered)


Remembering that pets are an investment of your time and money, can you afford to provide medical care, grooming, proper diet, proper shelter and exercise for your new pet? Please write you name, if yes: *

Do you agree to return the pet to this rescue if you find that you cannot keep the animal and provisions cannot be made for the safekeeping of this pet? Please write your name, if yes: *

I understand that this document is a legal binding contract once signed by the applicant.

I understand that this document is not in itself an agreement to adopt an animal but only a preliminary step in the desire to do so. Terms and Conditions of Adoption are as follows:

When the animal is delivered to the applicant and placed under his/her care, the adoption will have been said to have taken place.

I also understand that by adopting a pet from “One Life To Live Pet Rescue and Adoption,” no guarantees will be made to the future character development of the said pet. I will therefore hold harmless “One Life To Live Pet Rescue and Adoption” and its volunteers for any behavior problems, up to and including destructive behavior, separation anxiety disorder and aggression problems that may be present or develop post adoption.

I understand that follow-up home visits are a part of this adoption agreement. If at any time, one of our adopted or fostered animals is found to be chained, abused or in any way neglected, an agent of “One Life To Live Pet Rescue and Adoption” does retain the right to come onto the property and remove the animal.

In the event that I am no longer able to keep the pet listed below, I agree that it will be returned to “One Life To Live Pet Rescue and Adoption” immediately or I will inform the rescue of what provisions have been made to ensure the well-being of this animal and advise of the location of the animal.

I attest that the Terms and Conditions of Adoption as stated in the Adoption Application have been read in full by me and I understand that this is part of the adoption process and will be enforced. I attest that the information provided on this application is true and accurate to the best of my knowledge. Any false information given will warrant this application being disapproved immediately.

Applicant Signature (type name) *

Date: *

* Required