Today's Date *
First Choice (Animal Name) *
Second Choice (Animal Name) *
First Name *
Last Name *
Address *
City *
State *
Zip Code *
Email Address *
Telephone Number (best number to reach you) *
Your Date of Birth *
Your Occupation & Employer Name *
If you have a Facebook account, please paste the link here: *
Do you live in a house, condo/townhome, apartment, or a mobile home? *
How long have you lived at your current address? *
Do you rent or own your home? *
If renting, please provide your landlord's name and phone number: *
Do you have a fenced yard? *
No Yes
If so please list the type and height of the fencing. *
If you do not have a fence, what is your plan for the dog you are going to adopt to go to the bathroom? *
Do you have a pool? *
No Yes
If so is it in ground or above ground? *
How will the dog be kept safe from the pool? *
Are you planning to move within the next year, and if so, what are your plans for your companion animal when you move? *
What provisions have you made for your companion animal in the event of your illness or death? *
How many adults live in your home and what are their relationships? *
How many children live in the home and what are their ages? *
Please explain what experience your children have with pets: *
Do you frequently have children visit your home? *
Please describe the energy level in your home: *
Are all members of your household aware of your plans to adopt an animal? *
Does anyone in your household smoke, and if so, where? *
Are any members of your household allergic to animals? If yes, please describe the severity of their allergies: *
Where will your companion animal sleep? *
How many hours per day will your companion animal be alone? *
Who will have primary responsibility for the animal? *
Do you have any health conditions which could restrict your ability to care for an animal? If so, please explain: *
How often do you go on vacation, and who will care for your companion animal when you go? *
Do you have any cats? If so, please state name/breed/age, how many and whether they live indoors and/or outdoors: *
If you own cats, are they declawed? *
Are your cats spayed or neutered? *
Do you have any dogs? If so, please state name/breed/age, how many and whether they live indoors and/or outdoors: *
Are your dogs spayed or neutered? *
Do you have any other animals? If so, please describe: *
Please give the name, address, and phone number of your veterinarian: *
Please list any other animals you have owned in the past 10 years (other than the ones listed above) and where they are now: *
Have you ever turned an animal into an animal shelter or rehomed one of your pets? If so, please explain why: *
Have you previously adopted from an animal shelter or rescue group? If yes, which one? *
Why do you want to adopt an animal? *
What type of personality are you looking for in a pet? *
Tell us a little about yourself (hobbies, interests, etc.): *
Do you plan to do any structured activities with the animal (agility, lure-coursing, hunting, dock diving, obedience)? *
What is your experience with housebreaking, and how do you plan to accomplish housebreaking if the pet you wish to adopt is not housebroken? *
What brand of food do you plan to feed your pet (also tell canned or dry)? *
If your pet became ill, how much would you be able to spend on emergency care? *
How much do you expect to spend on routine care for your new family member? *
Do you understand that all veterinary expenses incurred post-adoption will be your responsibility? *
No Yes
Do you understand that while we do our very best to have animals checked thoroughy by our vets to ensure their health, sometimes illnesses may not present themselves until after adoption? *
No Yes
Are you applying for an animal with any other rescue or looking at breeders for puppies/kittens at the present time; meaning have you put in or do you plan to put in an adoption application elsewhere as well as with us? *
No Yes
If necessary, how will you discipline the animal? *
What flea/tick and heartworm products do you or have you used? *
In your own words, tell us what you know about heartworm disease: *
I hereby certify that all information supplied by me on this application is true. *
DATE *