Canyon Lake Animal Shelter <br>Pre Adoption Application

Date:

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Animal you are interested in adopting

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Date of Birth : Must be 18 to adopt

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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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Apartment Number (if applicable)

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City

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State

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Zip Code

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Email Address

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Main Phone Number

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Alternate Phone Number

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

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How did you find out about us?

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Have you been convicted of a crime involving animals?

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If yes, please explain:

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Have you ever had a pet euthanized?

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If yes, please explain:

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

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If yes, what is the method of exercise?

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If you answered "other" above, please explain:

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

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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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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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Are your pets current on their vaccinations?

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

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If you answered "other" above, please explain:

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

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If you answered "other" above, please explain:

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

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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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How do you feel about having pets spayed/neutered?

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Are you familiar with heartworm and heartworm prevention?

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

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Were any of your pets obedience trained?

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

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Please describe in detail the pet you are looking for.

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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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How long have you lived at this address?

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

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Landlord/Building Name

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Phone Number:

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Address:

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Including yourself, how many people live in your household?

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

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

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Employment Status

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If you chose "other" above, please explain:

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

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

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

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

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

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

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

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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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If you answered "other" above, please explain:

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How will you handle housebreaking?

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How will you handle behavior problems?

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

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If no, please explain:

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

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Will you allow us to perform home checks?

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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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