Adoption Application

Animal you are interested in adopting

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Applicant's First Name

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Applicant's Last Name

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Street Address

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City

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State

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Apartment Number (if applicable)

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Zip Code

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Phone Number

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Alternate Phone Number

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Email Address

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Date of Birth

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Drivers License Number

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How did you find out about us?

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Have you applied anywhere else for a pet?

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If yes, where else have you applied for a pet?

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Is this pet for you or someone else?

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Do you own other pets at the current time?

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If yes, please list their names, breeds, and ages.

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Are all of your pets spayed/neutered/fixed?

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How many pets have you owned in the last 5-10 years?

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What happened to them?

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Are your pets current on their vaccinations?

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Have you ever turned your dog or cat into a shelter?

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If yes, please explain?

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Veterinarian's Name

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Veterinarian's Address, City, State, and Zip Code

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Veterinarian's Phone Number

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Do you own or rent your home?

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Please select your current residence type.

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If you answered "other" above, please explain here:

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If you rent, does your landlord and lease allow pets?

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Including yourself, how many people live in your household?

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How long have you lived at this address?

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Please list the ages & relationship of those who live in your home.

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Is everyone in your household aware that you are planning to adopt a pet?

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Does anyone in your household have allergies to dogs/cats?

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Are you familiar with heartworm and heartworm prevention?

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On average, how many hours per day will your pet be left alone?

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Will this pet be predominantly living inside, outside, or both?

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Do you have a completely fenced-in yard? If so, what kind of fence?

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If you answered "other" above, please explain:

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If you do not have a fenced yard, how will you let the animal out?

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Where will the animal sleep?

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If you answered "other" above, please explain:

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Will the animal spend any time in the garage?

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If the animal will spend time in the garage, please explain when/why:

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What would you do with your animal if you had to move?

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If you answered "other" above, please explain:

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Are you willing to take responsibility for this animal for the next 10-20 years?

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If no, please explain:

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I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.

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