Adoption Application

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 *
If you are interested in a specific pet, please list it's name.
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
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?	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:
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
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:
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
If you rent, please provide your landlord's name and phone number. If it is not provided, your application will be automatically denied.
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
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
How will you handle housebreaking?
How will you handle destructive behavior?
Are you willing and able to exercise the animal on a regular basis?	Yes No N/A
Have you ever been convicted of abuse or neglect of a child or animal?	NoYes
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:
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 also aware that just because I completed this application, I am not guaranteed adoption of said animal(s). 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. *	NoYes
Please Sign Your Name Below *	Clear