Adoption Application

Animal you are interested in adopting
Applicant's First Name *
Applicant's Last Name *
Street Address *
Apartment Number (if applicable) *
City *
State *
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 *
Do you own other pets at the current time?
If yes, please list their names, breeds, and ages.
Have you ever turned your dog or cat into a shelter?
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
Do you own or rent your home? *
Please select your current residence type. *
How long have you lived at this address?
If you rent, does your landlord and lease allow pets?
If you are employed, what is your current occupation?
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. *
Please Sign *