Adoption Application

Thank you for your enquiry - we will be in touch with you shortly. Please note that these enquiries do not place animals on hold or prevent adoptions from happening in shelter.

Animal you are interested in adopting	Amara (Cat - S2023108) Ares (Cat - S2023058) Kimba (Cat - 201565437161) Kylo (Cat - S2023057) Lays (Cat - S2023067) Mama Mary (Dog - F2022006) Olive Garden (Cat - S2023120) Osha (Cat - S2023056) Sova (Cat - S2023002) Tippy (Dog - F2023015) Ziti (Dog - F2022010)
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Postal Code
Phone Number
Email Address
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?	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
Veterinarian's Address, City, State, and Zip Code
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
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 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?
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?	NoYes
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?	NoYes
Have you ever been convicted of abuse or neglect of a child or animal?	NoYes
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