Adoption Application

Animal you are interested in adopting
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
Date of Birth
Drivers License Number
How did you find out about us?	Petfinder Internet Search Family/Friend Staff/Volunteer Facebook/Twitter Other
Have you applied anywhere else for a pet?	NoYes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?	Myself Someone else
Do you own other pets at the current time?	NoYes
Are all of your pets spayed/neutered/fixed?	Yes No N/A
Are your pets current on their vaccinations?	Yes no n/a
Have you ever turned your dog or cat into a shelter?	NoYes
If yes, please explain?
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number
Have you ever had a pet euthanized?	NoYes
If yes, please explain:
Are you familiar with heartworm and heartworm prevention?	NoYes
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 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
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
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.
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)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?	Yes No N/A
If yes, when will they be tied/chained up?
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:
Will the animal spend any time in the garage?	Yes No N/A
If the animal will spend time in the garage, please explain when/why:
Do you have a pool?	NoYes
Is there a fence around the pool?	N/A Yes No
What kind of fence do you have around your pool?	N/A Wood Chain Link Plastic Iron Other
If you answered "other" above, please explain:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?	NoYes
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?	NoYes
If yes, 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?
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?	NoYes
If no, please explain:
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. Adopter fully understands and agrees to the lifetime commitment of an adoption through the Winchester Animal Shelter. Adopter agrees the dog is to be a family companion and agrees to provide the dog with a safe home, adequate food, water, proper care, exercise, love and attention. Adopter is aware the dog may exhibit normal but potentially undesirable behaviors including, but not limited to aggression, house soiling, biting, scratching, chewing, barking, digging, urine marking, and these behavior patterns require patience and training on part of adopter. Winchester Animal Shelter makes no guarantees or statements regarding the dog’s age, breed, health or temperament. Winchester Animal Shelter has made every effort to provide accurate history and assessment of the dog. Adopter accepts this dog AS IS with all defects, either observable or unobservable and assumes all risk for the dog upon the signing of this contract. I hereby agree that the adoption fee of $150.00 helps to cover the expense of said animal to be spayed or neutered, UTD shots, Heartworm testing and vet check as required by law. Adopter also agrees that NO REFUNDS are given on adopted dogs.	Yes No