Adoption Application

Applicant's First Name *
Animal you are interested in adopting
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code
Phone Number Please use the following format 248-555-1212
Alternate Phone Number
Email Address Please enter correctly as this is the main way we will contact you
Date of Birth
Two unrelated personal references name & phone
Have you applied anywhere else for a pet?	Yes No
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? *	Yes No
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 10 years?
What happened to them?
Have you ever turned your dog or cat into a shelter?	Yes No
If yes, please explain?
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number
Are your pets current on their vaccinations?	Yes No N/A
How do you feel about having pets spayed/neutered?	Agree Disagree Not Sure
Have you ever had a pet euthanized?	Yes No
If yes, please explain:
Will you keep the animal up-to-date on vaccinations and heartworm preventative? *	Yes No
If no, please explain:
Please check the main reason you plan to adopt a pet:	Companion Family Pet 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.
If you answered "other" above, please explain here:
How long have you lived at this address?
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 names, 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?	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?	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 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?
Are there times when the animal will be tied/chained up?	Yes No N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?	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:
If the animal will spend time in the garage/basement, please explain when/why:
How will you handle destructive behavior?
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?
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal? *	Yes No
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?	Yes No
If no, please explain:
Will you allow us to perform home checks?	Yes No
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