1. Animal's Name of Interest *
Alerez (Dog - D1004236943)
Anne Wilkes (Dog - D1004236952)
Blitz (Dog - D1004236979)
Cappuccino (Dog - D0602226079)
Chloe (Dog - D1004236981)
Cruz (Dog - D0730236857)
Dinah (Cat - C0720236834)
Elin (Dog - D0802236845)
Griffin (Dog - D0901236905)
Joker (Dog - D0802236873)
Lily (Chi2) (Dog - D1004236965)
Lobo (Dog - D0901236914)
Lorna (Dog - D1004236951)
Maliya (Dog - D1004236980)
Milky Way (Dog - D1004236967)
Mona (Dog - D0604236787)
Napoleon (Dog - D0924236940)
Orange (Dog - D1004236999)
Panda (Dog - D0901236920)
Red (Dog - D1004237000)
Rosie (Dog - D1123204812)
Rudy (Dog - D0601215383)
Scooter (Dog - D1002236993)
Serena (Chi1) (Dog - D1004236960)
Shelda (Dog - D1004236972)
Shelder (Dog - D1004236982)
Sheldra (Dog - D1004236969)
Shelly (Dog - D1004236976)
Snickers (Dog - D1004236957)
Spector (Cat - C0720236883)
Sugar (Dog - D1016204621)
Waldi (Dog - D1004237001)
Walli (Dog - D1004237002)
Weena (Dog - D1004237003)
Wildcat (Dog - D1004236977)
Willy (Dog - D1004236970)
2. Is the animal a dog or cat? *
Dog
Cat
3. Applicant's First Name *
4. Applicant's Last Name *
5. Street Address *
6. City *
7. State *
8. Apartment Number (if applicable)
9. Zip Code *
10. Phone Number *
11. Email Address *
12. Alternate Phone Number
13. Date of Birth *
14. Drivers License Number
15. How did you find out about Almost Home? *
Petfinder Web Site
Internet Search
Family/Friend
Almost Home Staff or Volunteer
Facebook/Twitter
Almost Home Alumni
Other
16. Have you applied anywhere else for a pet? *
No Yes
17. If yes, where else have you applied for a pet?
18. Is this pet for you or someone else? *
Myself
Someone else
19. Do you own other pets at the current time? *
No Yes
20. If yes, please list their names, breeds, and ages.
21. Are all of your pets spayed/neutered/fixed? *
Yes
No
N/A
22. How many pets have you owned in the last 5-10 years? *
23. What happened to them? *
24. Are your pets current on their vaccinations? *
Yes
no
N/a
25. Have you ever turned your dog or cat into a shelter? *
No Yes
26. If yes, please explain?
27. Veterinarian's Name *
28. Veterinarian's Address, City, State, and Zip Code *
29. Veterinarian's Phone Number *
30. Have you ever had a pet euthanized? *
No Yes
31. If yes, please explain:
32. How do you feel about having pets spayed/neutered? *
Agree
Disagree
Not Sure
33. Are you familiar with heartworm and heartworm prevention? *
No Yes
34. If you have pets, will they adjust to a new pet in the house? *
Yes
No
Unsure
N/A
35. Were any of your pets obedience trained? *
Yes
No
N/A
36. Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
37. If you answered "other" above, please explain here:
38. Please describe in detail the pet you are looking for. *
39. Do you own or rent your home? *
Own
Rent
Someone else owns the Home
Someone else rents the Home
40. Please select your current residence type. *
House
Apartment
Condo
Townhouse
Mobile Home
Other
41. If you answered "other" above, please explain here:
42. How long have you lived at this address? *
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
43. If you rent, does your landlord and lease allow pets? *
Yes
No
Unsure
N/A
44. Including yourself, how many people live in your household? *
45. Please list the ages & relationship of those who live in your home. *
46. Is everyone in your household aware that you are planning to adopt a pet? *
Yes
No
N/A
47. Does anyone in your household have allergies to dogs/cats? *
Yes
No
Possibly
N/A
48. Employment Status *
Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
49. If you chose "other" above, please explain:
50. If you are employed, what is your current occupation? *
51. On average, how many hours per day will your pet be left alone and where will they be kept? *
52. How much do you think the annual medical bills will be for your pet? *
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
53. What would you do if the bills went over this amount? *
54. Will this pet be predominantly living inside, outside, or both? *
Inside
Outside
Both
55. Please provide a description of this pet's living conditions. *
56. Do you have a completely fenced-in yard? If so, what kind of fence? *
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
57. If you answered "other" above, please explain:
58. If you do not have a fenced yard, how will you let the animal out? *
59. Are there times when the animal will be tied/chained up? *
Yes
No
N/A
60. If yes, when will they be tied/chained up?
61. Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
62. If you answered "other" above, please explain:
63. Will the animal spend any time in the garage? *
Yes
No
N/A
64. If the animal will spend time in the garage, please explain when/why: *
65. Do you have a pool? *
No Yes
66. Is there a fence around the pool? *
N/A
Yes
No
67. What kind of fence do you have around your pool? *
N/A
Wood
Chain Link
Plastic
Iron
Other
68. If you answered "other" above, please explain:
69. How will you handle housebreaking? *
70. How will you handle destructive behavior? *
71. Will you keep the animal up-to-date on vaccinations and heartworm preventative? *
No Yes
72. If no, please explain:
73. Are you willing and able to exercise the dog on a regular basis? *
Yes
No
N/A
74. If yes, what is the method of exercise? *
Walking
Running
Dog Park / Dog Run
Other
75. If you answered "other" above, please explain:
76. Have you ever been convicted of abuse or neglect of a child or animal? *
No Yes
77. If yes, please explain:
78. If you drive a pick up truck, would you allow the animal to ride in the back/bed? *
Yes
No
N/A
79. What arrangements will you make for the care of your pets in case of an emergency? *
Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
80. If you answered "other" above, please explain:
81. What will you do with the animal when you go on vacation? *
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
82. If you answered "other" above, please explain:
83. For what reason(s) would you consider returning/giving up the animal? *
84. What would you do with your animal if you had to move? *
Take him / her with me
Give to family or friend
Return to shelter
Other
85. If you answered "other" above, please explain:
86. Are you willing to take responsibility for this animal for the next 10-20 years? *
No Yes
87. If no, please explain:
88. Will you allow Almost Home to preform home checks? *
No Yes
89. If no, please explain why you will not allow a home check.
90. 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 Almost Home to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal. *
Yes
No