I agree to the following Adoption fee(s)s: Kitties under 2 yrs old: $140 or $250 for 2; cats 2-7 yrs: $110 or $200 for 2; cats 8+yrs: $75 or $125 for 2 *
No Yes
Animal you are interested in adopting
Second animal choice/option
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number
Please use the following format 248-555-1212
Email Address *
Please enter correctly as this is the main way we will contact you
Alternate Phone Number
What is a good number for you to receive text messages regarding your cats spay or neuter surgery? *
Date of Birth
Drivers License Number
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Who referred you to our program?
Have you applied anywhere else for a pet?
No Yes
If yes, where else have you applied for a pet?
Is this pet for you or someone else? If someone else please explain.
Myself
Someone else
Are there other pets living in your home at this time?
No Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?
Yes
no
n/a
Have you ever turned your dog or cat into a shelter?
No Yes
If yes, please explain?
Veterinarian's Name
If you have never owned a pet please tell us where you would go.Please contact your veterinarian and give them permission to release your information to us.
Veterinarian's Address, City, State, and Zip Code
Again if you have never owned a pet please list where you would go
Please contact your vet to have them release information to us
Veterinarian's Phone Number
Have you ever had a pet euthanized?
No Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
Agree
Disagree
Not Sure
If you have pets, will they adjust to a new pet in the house?
Yes
No
Unsure
N/A
Were any of your pets obedience trained?
Yes
No
N/A
Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Companion for another pet
Other
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
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
If you rent, does your landlord and lease allow pets?
Yes
No
Unsure
N/A
Landlord name and phone number
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
Yes
No
Possibly
N/A
Employment Status
Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone?
How much do you think the annual medical bills will be for your pet?
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
Please provide a description of this pet's living conditions.
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
If you answered "other" above, please explain:
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations?
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
No Yes
If yes, please explain:
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
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
I agree to contact A.K.A. immediately if for any reason I can no longer care for or keep the adopted animal,
No Yes
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
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
No Yes
If no, please explain:
Will you allow us to perform home checks?
No Yes
I understand that if I don't use A.K.A. to spay or neuter my cat that it needs to be completed by the time the cat turns 8 months old or I will be in violation of our adoption agreement. *
No Yes
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.
Yes
No