Adoption Application

Animal you are interested in adopting
Applicant's First Name *
Applicant's Last Name *
Street Address & Apartment Number (if applicable) (NO PO Boxes) *
City *
State *
Zip Code *
Cell Number/Main Number * Please use the following format 248-555-1212.
Alternate 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 and required for microchip registration.
Date of Birth *
Last 4 of Social Security Number (This will be kept confidential, for background check only.) * This will be kept confidential, for background check only.
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?	Yes No
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?	Yes No
If yes, please list their names, breeds, and ages.
How do you feel about having pets spayed/neutered?	Agree Disagree Not Sure
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
Are you familiar with heartworm and heartworm prevention? *	Yes No
Have you ever turned your dog or cat into a shelter?	Yes No
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 *
Please provide 2 references, please include name, relationship, phone number and email address *
Have you ever had a pet euthanized?	Yes No
If yes, please explain:
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 Child's Pet Guard Dog Companion for another pet Service Dog 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
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, who is your current employer?
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:
Do you have a pool?	Yes No
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?	Yes No
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?	Yes No N/A
If yes, what is the method of exercise?	Walking Running Dog Park / Dog Run Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?	Yes No
If yes, please explain:
If you drive a pick up truck, would you allow the animal to ride in the back/bed?	Yes No N/A
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?
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? *	Yes No
If no, please explain:
What is your backup plan for your adopted pet if something happens to you? *
Will you allow us to perform home checks? *	Yes No
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