Canyon Lake Animal Shelter <br>Pre Adoption Application

Date:

Animal you are interested in adopting

Date of Birth : Must be 18 to adopt *

Applicant's First Name *

Applicant's Last Name *

Street Address *

Apartment Number (if applicable)

City *

State

Zip Code *

Email Address *

Main Phone Number *

Alternate Phone Number

Please check the main reason you plan to adopt a pet: *

How did you find out about us? *

Have you been convicted of a crime involving animals? *

If yes, please explain:

Have you ever had a pet euthanized?

If yes, please explain:

Are you willing and able to exercise the dog on a regular basis?

If yes, what is the method of exercise?

If you answered "other" above, please explain:

If you drive a pick up truck, would you allow the animal to ride in the back/bed?

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

What happened to them?

Do you own other pets at the current time? *

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

Are all of your pets spayed/neutered/fixed?

Are your pets current on their vaccinations?

What arrangements will you make for the care of your pets in case of an emergency?

If you answered "other" above, please explain:

What will you do with the animal when you go on vacation?

If you answered "other" above, please explain:

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

If yes, please explain?

For what reason(s) would you consider returning/giving up the animal? *

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

If you answered "other" above, please explain:

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

If no, please explain:

How do you feel about having pets spayed/neutered?

Are you familiar with heartworm and heartworm prevention?

Veterinarian's Name *

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

Veterinarian's Phone Number *

If you have pets, will they adjust to a new pet in the house?

Were any of your pets obedience trained?

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

Please describe in detail the pet you are looking for. *

Do you own or rent your home?

Please select your current residence type.

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

How long have you lived at this address?

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

Landlord/Building Name

Phone Number:

Address:

Including yourself, how many people live in your household? *

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

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

Employment Status

If you chose "other" above, please explain:

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

How much do you think the annual medical bills will be for your pet?

What would you do if the bills went over this amount?

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

Please provide a description of this pet's living conditions. *

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

If you answered "other" above, please explain:

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

Are there times when the animal will be tied/chained up?

If yes, when will they be tied/chained up?

Where will the animal sleep?

If you answered "other" above, please explain:

Will the animal spend any time in the garage?

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

If you answered "other" above, please explain:

How will you handle housebreaking? *

How will you handle behavior problems? *

Will you keep the animal up-to-date on vaccinations and heartworm preventative?

If no, please explain:

List two references: Name and Number (Please do not include family members): *

Will you allow us to perform home checks?

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. *