Tullahoma Animal Shelter Adoption Application
Animal you are interested in adopting
Applicant's First Name
*
Applicant's Last Name
*
Street Address
*
Apartment Number (if applicable)
City
*
State
*
Zip Code
*
Phone Number
*
Would you like to add a photo of yourself for your profile?
Email Address
Date of Birth
*
Please submit a photo of your state issued Driver's License or ID card.
*
Please submit your License or ID Number.
What is your Annual Household Income?
*
Under$25,000
$25,000-$50,000
$50,0000-$70,000
$70,000 or higher.
Is this pet for you or someone else?
*
Myself
Someone else
Do you own other pets at the current time?
*
No
Yes
List their names as they appear on your vet paperwork.
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
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No
Yes
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?
*
No
Yes
Have you ever turned your dog or cat into a shelter?
*
No
Yes
If yes, please explain?
Veterinarian's Name
*
Veterinarian's Address, City, State, and Zip Code
*
Veterinarian's Phone Number
*
Have you ever had a pet euthanized?
*
No
Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
*
Agree
Disagree
Not Sure
Are you familiar with heartworm and heartworm prevention?
*
No
Yes
Do you own or rent your home?
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Own
Rent
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
What is your Landlord's Name? (if applicable)
*
What is your landlord's phone number?
*
If you rent, does your landlord and lease allow pets?
*
Yes
No
Unsure
N/A
Please list the ages & relationship of those who live in your home.
*
Does anyone in your household have allergies to dogs?
*
No
Yes
On average, how many hours per day will your pet be left alone?
*
Will this pet be predominantly living inside, outside, or both?
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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)
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?
*
No
Yes
If yes, when will they be tied/chained up?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
*
No
Yes
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
*
No
Yes
If yes, 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?
*
No
Yes
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
Signature
*
Clear
Today's Date
*