Animal you are interested in adopting
Clawsby (Cat - S2024241)
Dipper Pines (Cat - S2024254)
Elphaba (Dog - F2024046)
Grayson (Cat - S2024257)
Jiro (Cat - S2024258)
Madame Morrible (Dog - F2024042)
Mish (Dog - F2023028)
Mussa (Cat - S2024239)
Nausicca (Cat - S2024262)
Ohmu (Cat - S2024261)
Peach the Mammoth (Cat - S2024226)
Queen Queso (Dog - U2024004)
R2D2 (Cat - S2024278)
Rona (Cat - S2024269)
ShenShen (Dog - F2024047)
Wild Wasabi (Cat - S2024249)
Woolemina Mammoth (Cat - S2024227)
Yakul (Cat - S2024265)
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Postal 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
Date of Birth
Drivers License Number
How did you find out about us?
Family/Friend
Internet Search
Staff/Volunteer
Facebook/Twitter
Other
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?
Myself
Someone else
Do you own other pets at the current 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.
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?
No Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
Agree
Disagree
Not Sure
Are you familiar with heartworm and heartworm prevention?
No Yes
If you have pets, will they adjust to a new pet in the house?
Yes
No
Unsure
N/A
Were any of your pets professionally 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
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, what is your current occupation?
On average, how many hours per day will your pet be left alone?
How will the animal be contained when you are away?
For example, will it be crate trained or left to roam the house?
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
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 do not have a yard with a fence over 6 feet high, how will you let the animal out?
Are you prepared should your new pet not be housebroken?
No Yes
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
No Yes
Have you ever been convicted of abuse or neglect of a child or animal?
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