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) would you like to adopt and why?:



APPLICANT INFORMATION  


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?:



YOUR HOME  


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



PERSONAL REFERENCES  

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


Name:  
Address:   Phone:


Name:  
Address:   Phone:



CARE AND RESPONSIBILITY  


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

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  Don't Know   If yes, 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



HISTORY OF PET OWNERSHIP  


Please list your current pets:

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

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

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

4.) Name:      Type: Cat  Dog    Breed:      Age: 
     Spay 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: 



ADDITIONAL COMMENTS  




AFFIRMATION  


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 would you like us to contact you?
E-mail
Phone
Day
Evening

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





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