Adoption Reservation Application

I understand this form is not an application to adopt. It is to place a reservation on a potential animal I may be interested in adopting. It does NOT guarantee approval for adoption. *
Animal you are interested in adopting *
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
Confirm email
Alternate Phone Number
Date of Birth *
Drivers License Number *
Have you ever surrendered a pet? *
If yes, explain why and where
Have you ever been charged with any crime against animals (abuse, neglect, ect/)? *
If yes, explain why