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? *

Is this pet for you or someone else? *

Do you own other pets at the current time? *

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? *

How many pets have you owned in the last 5-10 years?

What happened to them?

Are your pets current on their vaccinations? *

Have you ever turned your dog or cat into a shelter? *

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? *

If yes, please explain:

How do you feel about having pets spayed/neutered? *

Are you familiar with heartworm and heartworm prevention? *

Do you own or rent your home? *

Please select your current residence type.

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? *

Please list the ages & relationship of those who live in your home. *

Does anyone in your household have allergies to dogs? *

On average, how many hours per day will your pet be left alone? *

Will this pet be predominantly living inside, outside, or both? *

Do you have a completely fenced-in yard? If so, what kind of fence? *

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? *

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? *

If no, please explain:

Have you ever been convicted of abuse or neglect of a child or animal? *

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?

If you answered "other" above, please explain:

Are you willing to take responsibility for this animal for the next 10-20 years? *

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. *

Signature *

Today's Date *