ADOPTION APPLICATION

Which pet(s) would you like to adopt and why?:

Applicant's Name:
Spouse's Name (if applicable):

Address:
City:   State:   Zip:   County:

Home Phone:   Cell:   Work:

E-mail address:

Number of Adults in your household:
Number of Children and their ages: 

Place of Employment:   How long?:

Apartment/Townhouse/Condo

House/Duplex

Live with Parents

Other: 

Do you own or rent your home?  Own  Rent

If you rent, please provide your landlord's contact information:
Name:   Phone:

Does your lease/homeowners association restrict ownership of pets? Yes  No

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

Does anyone in your home smoke? Yes No

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

Name:  
Address:   Phone:

Name:  
Address:   Phone:

Are your prepared to make a commitment to care for this dog/cat for the next 10-15 years (in the case of a dog) or 18-20 years (in the case of a cat)?:
Yes  No  Don't Know

What is your age?:
under 21 yrs  21-40 yrs  41-65 yrs  over 65 yrs

Are you prepared to commit to find a home where you can keep this dog/cat if/when you move during the life of your pet?:
Yes  No  Don't Know

Are you financially prepared to deal with the cost of both routine (vaccinations, annual exams, dental cleanings, heartworm prevention, etc.) and non-routine/emergency veterinary care for this dog/cat?
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 dog/cat sleep at night?:  

Where will your dog/cat spend most of the day?:  

If you become unable to care for your pet(s) (such as being incapacitated or upon your death), do you have a plan in place as to what will happen to them?
Yes  No  Don't Know

Who will have primary responsibility for the care of the dog/cat?:  

If you are considering adopting a cat, do you intend to declaw him/her?:
Yes  No  Unsure   If yes or unsure, why?: 

How many days are you willing to spend adjusting to and helping your new pet adjust to your home and lifestyle?: 

Under what circumstances would you not keep the pet if behavioral issues develop?:

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

Please list your current pets:

1.) Name:     Type: Cat  Dog    Sex:      Age: 
     Spayed or Neutered? Yes  No   How long have you had this pet?: 
     Current on Vaccinations?: Yes  No

2.) Name:      Type: Cat  Dog    Sex:      Age: 
     Spayed or Neutered? Yes  No   How long have you had this pet?: 
     Current on Vaccinations?: Yes  No

3.) Name:      Type: Cat  Dog    Sex:      Age: 
     Spayed or Neutered? Yes  No   How long have you had this pet?: 
     Current on Vaccinations?: Yes  No

4.) Name:      Type: Cat  Dog    Sex:      Age: 
     Spayed or Neutered? Yes  No   How long have you had this pet?: 
     Current on Vaccinations?: Yes  No

(If you have additional pets, please list them in the "comments" field at the end of this form.)

Where are the pets kept during the day?:    At night?: 

Please list previous pets that you've owned in the last five years (not including your current pets):

1.) Name:   Type: Dog  Cat   Owned how long?:
     When and why did the relationship end? 

2.) Name:   Type: Dog  Cat   Owned how long?:
     When and why did the relationship end? 

3.) Name:   Type: Dog  Cat   Owned how long?:
     When and why did the relationship end? 

4.) Name:   Type: Dog  Cat   Owned how long?:
     When and why did the relationship end? 

(If you've had additional pets, please list them in the "comments" field at the end of this form.)

Your Current Veterinarian:   Phone: 

All of the information that I have provided above is true and complete to the best of my knowledge. Should a dog or cat be placed with me, it will reside in my home as a pet. I agree to provide the dog/cat with adequate food, water, shelter, affection, and medical 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