Adoption Application

Animal you are interested in adopting	Amber (Cat - C2026041) Blaze (Cat - C2026040) Eugene (Dog - D2026022) Pepper (Cat - C2026030) Phoebe (Dog - D2024142) Sid (Dog - D2026027) Sparks (Cat - C2026042) Sugar (Cat - C2026031) Sunrise (Cat - C2026038) Sunset (Cat - C2026039)
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
How did you find out about us?	Petfinder Internet Search Family/Friend Staff/Volunteer Facebook/Twitter Other
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
How many pets have you owned in the last 5-10 years?
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?
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.
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
On average, how many hours per day will your pet be left alone?
Will this pet be predominantly living inside, outside, or both?	Inside Outside Both
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)
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 you answered "other" above, please explain:
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 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:
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
Adopter signature *	Clear
Date
Do you grant unrestricted usage of your image and/or name without prior notification? And, do you acknowledge that there will not be any compensation for the use of these images? Such use includes the display, distribution, publication, transmission or other use of photographs, images, and/or videos taken for the use in materials that include but not limited to printed materials such as brochures, newsletters, videos and digital images on Loving All Animals' website or social media sites.	NoYes