ADOPTION APPLICATION



INSTRUCTIONS

This application is intended to be a guide to help you think about all of the ways that a new cat or dog will impact your life. All of the questions concern various aspects of pet ownership that should be given serious consideration before deciding to share your life with any dog or cat.

When finished, click the "SUBMIT" button at the bottom of the form.

DO NOT HIT the ENTER key or your application will be prematurely submitted.
If you accidentally do this, hit the BACK key/arrow and you won't have to start all over.


Which pet(s) are you interested in?

Please type the name(s) of any cat(s) you are interested in adopting. (Specify "dog" if you are applying to adopt a dog.) If you do not have a specific pet in mind, please leave this box blank.



APPLICANT INFORMATION  


Applicant's Name:

Spouse/Partner Name (if applicable):


Address:

City:   State:   Zip:   County:


Cell Phone Number:             Preferred Contact:  Email  Text

E-mail address:


Number of Adults in your household:   

Their Names:

Number of Children and their ages: 


Employer/Source of Income:   How long?

Are you 18 or over?  Yes  No



YOUR HOME  


Do you own your home, rent your home, or live with your parents?  Own  Rent  Live with parents

If you rent, please provide your apartment complex or landlord's name and phone number:
Name:   Phone:

Do you live with roommates?  Yes  No



HISTORY OF PET OWNERSHIP  


What animals currently live in your household?

1.) Pet Name:       Cat  Dog  Other       Sex: 
     Spayed/Neutered? Yes  No     How long have you had this pet? 
     Does this pet live indoors or outdoors? Indoors  Outdoors     Age: 


2.) Pet Name:       Cat  Dog  Other       Sex: 
     Spayed/Neutered? Yes  No     How long have you had this pet? 
     Does this pet live indoors or outdoors? Indoors  Outdoors     Age: 


3.) Pet Name:       Cat  Dog  Other       Sex: 
     Spayed/Neutered? Yes  No     How long have you had this pet? 
     Does this pet live indoors or outdoors? Indoors  Outdoors     Age: 


4.) Pet Name:       Cat  Dog  Other       Sex: 
     Spayed/Neutered? Yes  No     How long have you had this pet? 
     Does this pet live indoors or outdoors? Indoors  Outdoors     Age: 


Your Current Veterinarian: 
Phone Number:
(Please call your vet and give them permission to speak with our volunteers.)


Pets you have had in the past 5 years that no longer live with you:

1.) Name:    Cat  Dog  Other
     How long did you own this pet?
     What happened to this pet? 

2.) Name:    Cat  Dog  Other
     How long did you own this pet?
     What happened to this pet? 

3.) Name:    Cat  Dog  Other
     How long did you own this pet?
     What happened to this pet? 

4.) Name:    Cat  Dog  Other
     How long did you own this pet?
     What happened to this pet? 

Your Previous Veterinarian: 
Phone Number:
(Please call your previous vet and give them permission to speak with our volunteers.)



CARE AND RESPONSIBILITY  


Do you intend to declaw the cat you wish to adopt? (What does it mean to declaw a cat? Click here to learn more.)
Yes  No     If so, why? 

Expenses for a pet average $1000 per year. Should a serious illness or accident occur the cost could be two to three times that amount. Are you prepared for these expenses?
Yes  No  Don't Know

Are your prepared to make a commitment to care for this cat/dog for 10-20 years (depending on age and breed)?
Yes  No  Don't Know

Approximately how many hours per day will your pet be alone?:
1-3 hrs  4-6 hrs  8 or more

Where will your cat/dog sleep at night?  

Where will your cat/dog spend the day?  

If you become unable to care for your pet(s) (such as incapacitation or death) what is your plan for their future care?

Who will be taking care of your pets in 15 years?

How many days are you willing to spend helping your new pet adjust to your home? 

Under what circumstances would you return the pet (i.e. moving, new baby, illness of pet)?

Are you willing to contact an animal behaviorist or trainer, if necessary?
Yes  No  Don't Know

What is the usual activity level in your home (i.e. busy, relaxed, loud, quiet)? 

Does anyone in your home smoke? Yes No



PERSONAL REFERENCES  

(References can include friends, neighbors, relatives, employer, coworkers)


Name:  
Relationship:
Phone Number:


Name:  
Relationship:
Phone Number:



FOR DOG ADOPTIONS ONLY  

Does your lease/homeowner's association restrict ownership of pets or breeds? Yes  No

Do you have a fenced yard? Yes  No
Type of Fence: 



ADDITIONAL COMMENTS  




AFFIRMATION  


All of the information that I have provided above is true and complete to the best of my knowledge. Should a cat or dog be placed with me, it will reside in my home as a pet. I agree to provide humane care and maintenance such as food, water, shelter, affection, and veterinary care.
Checking below constitutes an electronic signature.

I Agree  I Disagree     Date:  


How did you find the pet you are interested in adopting?
Internet
Visiting the shelter
Adoption Event
Mingle with the Mutts
Posted Flyer
Pet Store
Referral
Other





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If you see this, leave this form field blank.