Adoption Application

Animal you are interested in adopting *	Alfred (Dog - 25426) Asiri (Dog - 25224) Bill (Dog - 25223) Brad (Dog - 25428) Bugs (Dog - 25116) Ember (Dog - 25018) Jennifer (Dog - 25432) Lane (Dog - 25438) Lucie (Dog - 25439) Luv (Dog - 25437) Raven (Dog - 25416) Rocko (Dog - 25412) Romeo (Dog - 25041) Roxy (Dog - 25151) Roy (Dog - 25028) Samson (Dog - 25007) Uma (Dog - 25415) Zorn (Dog - 24066)
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
Alternate Phone Number
Date of Birth
Drivers License Number
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
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 If you have never owned a pet please tell us where you would go.
Veterinarian's Phone Number
If you have pets, will they adjust to a new pet in the house?	Yes No Unsure 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:
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 Dorm Townhouse Mobile Home Other
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
Will this pet be predominantly living inside, outside, or both?	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?
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?	NoYes
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?	NoYes
If yes, 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:
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?	NoYes
If no, please explain:
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