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 * Please use the following format 248-555-1212
Would you like to add a photo of yourself for your profile?
Email Address Please enter correctly as this is the main way we will contact you
Date of Birth *
Please submit a photo of your state issued Driver's License or ID card. *
Please submit your License or ID Number.
Do you own other pets at the current time? *	NoYes
List their names as they appear on your vet paperwork.
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 *
Do you own or rent your home? *	Own Rent
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
Will this pet be predominantly living inside, outside, or both? *	Inside Outside Both
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 yes, 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 *