Adoption Application

Animal you are interested in adopting *
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
Secondary Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is how we register the microchip
Date of Birth *
Drivers License Number *
How did you find out about us? *
Is this pet for you or someone else? *
Is everyone in your household aware that you are planning to adopt a pet? *
Does anyone in your household have allergies to dogs/cats? *
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
Veterinarian's Phone Number
Will you keep the animal up-to-date on vaccinations and heartworm preventative? *
If you have pets, will they adjust to a new pet in the house? *
If you have pets, please list their breed, sex, & age. *
Do you own or rent your home? *
Please select your current residence type. *
If you answered "other" above, please explain here:
If you rent, does your landlord and lease allow pets?
If you rent, please state the landlord's contact information. Name & phone number:
Please provide a description of this pet's living conditions. *
If you encounter problems (chewing, digging, scratching, etc.), how will you correct this behavior? *
For what reason(s) would you consider returning/giving up the animal? *
Are you willing to take responsibility for this animal for the next 10-20 years? *
If no, please explain:
The adopter assumes all risks associated with the adopted animal, including, but not limited to, physical health, disease, temperament, or pedigree. Brenham Animal Services will NOT be responsible for any accidents, injuries, or illnesses of any adopted animal. *
Signature *
Date *