Adoption Application
Name of Animal interested in.
*
Any dog (Dog - D2021372)
Archer (Dog - D2021604)
Camry (Dog - D2022064)
Cookie (Dog - D2023008)
Flower (Dog - D2023003)
Hershey (Dog - D2023012)
Hopper (Dog - D2022051)
Kiwi (Dog - D2022053)
London (Cat - C2022015)
Monty (Cat - C2022016)
Samantha (Dog - D2021601)
Stan (Dog - D2022017)
Sundae (Dog - D2023010)
Tito (Dog - D2022054)
Toffee (Dog - D2023006)
Applicant's Full name
*
Spouse/Partner name
E-Mail
*
Phone Number
*
Address
*
How long have you lived at this address?
*
Are you at least 21 years of age or older?
*
No
Yes
Can you provide a veterinary reference
*
If so please provide name of Veterinary
*
Your Occupation
*
Does your job require you to move frequently?
*
No
Yes
What is the reason you want to adopt this animal?
*
How did you find out about us?
*
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Are you the decision maker about adopting this dog?
*
No
Yes
Do you own your home?
*
No
Yes
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
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
*
Veterinarian's Address, City, State, and Zip Code
*
Veterinarian's Phone Number
*
Have you ever had a pet euthanized?
*
No
Yes
If yes, please explain:
Have you ever re-homed a pet?
*
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 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?
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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 much do you think the annual medical bills will be for your pet?
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About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
*
Will this pet be predominantly living inside, outside, or both?
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Inside
Outside
Both
Please provide a description of this pet's living conditions.
*
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 answered "other" above, please explain:
*
If you do not have a fenced yard, how will you let the animal out?
*
Where will the animal sleep?
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In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
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Do you have a pool?
*
No
Yes
Is there a fence around the pool?
*
N/A
Yes
No
What kind of fence do you have around your pool?
*
N/A
Wood
Chain Link
Plastic
Iron
Other
If you answered "other" above, please explain:
*
What do you know about potty training/housebreaking?
*
How will you handle destructive behavior?
*
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
*
No
Yes
If no, please explain:
*
Are you willing and able to exercise the dog on a regular basis?
*
Yes
No
N/A
If yes, what is the method of exercise?
*
Walking
Running
Dog Park / Dog Run
Other
If you answered "other" above, 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:
*
What will you do with the animal when you go on vacation?
*
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?
*
No
Yes
If no, please explain:
*
Will you allow us to perform home checks?
*
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