Name:
e-mail Address:
What type of pet are you looking for?
Do you have a preference as to breed, sex, age, size, length of hair etc?
if yes, what are your preferances?
Is this your first pet?
Place of Employment:
Employer's Address:
City: State:Zip:
Phone: Supervisor's Name:
Your Drivers licence # : State:
Date of Birth: Social Security #:
if you dont feel comfortable giving this information on-line please call me with it
Spouse's Name:
Spouse's Employer:
Employer's Address: City: State: Zip:
Phone: Supervisor's Name:
Spouse's Drivers licence #: State:
Date of Birth: Social Security#
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How did you hear about us?
How many pets do you currently have in your household?
Breed: Name: Age: Sex: Altered:
Where do you keep this pet?
Breed:Name: Age: Sex: Altered:
Where do you keep this pet?
Breed:Name: Age: Altered:
Are your pets current on all their vaccinations?
Heartworm preventative? Brand:
Have you had other pets that you no longer have?
If yes, please list them and state why you no longer have them:
If deceased, why?
Who is your veterinarian?
Phone #:
What is your current living situation?
Do you:
If you rent does your lease allow pets?
What is your landlords name:Phone #:
Are you financially able to take care of a new pet?
(feeding, routine vet care, vaccinations, parasite check, emergency vet care, licensing, etc...)
Are you willing to take responsibility for this pet for the rest of its life?
How will you provide for your pet when you must go out of town or on a vacation?
Can you make a commitment for the many years this pet could live? (10 or more)
Do you realize that some pets shed 365 days a year?
______________________________________________________________________
How long have you lived at your current address:
How many adults live in your household? How many children?
Do all the adults know that you plan to adopt?
If there are children what are their ages?
Is this pet for someone other than yourself? If yes, who?
Do you or does anyone living in your household have any known allergies to animals?
If yes, to what kinds of animals, and how severe is the allergy?
If yes, what actions do you plan to take to protect the person from having a reaction?
Who will be the responsible for the care of this pet?
Where will this pet be kept during the day? At night?
How many hours will it spend alone without human companionship per day?
Where will it be kept when alone?
Have you ever applied to adopt from a rescue or humane society before?
If yes, which one?Results?
List 3 personal references with phone numbers (NO RELATIVES OR WORK NUMBERS)
++++++++++++++++NEXT SECTION IS FOR DOG ADOPTONS ONLY+++++++++++++++++
If you are not adopting a dog, please skip to the end.
What do you want this dog for?
How will you keep your dog confined to your property?
Do you have a fenced in yard?
If yes, what kind?How high?
Do you plan on taking your dog to obedience training classes?
If No, what method will you use to train your dog?
Are you familiar with crating a dog?
Are you able to excercise your dog?
What methods will you use for exercising?
Are you aware that a bored dog will chew?
++++++++++++++++++++++++++FOR ALL ADOPTERS++++++++++++++++++++++++++
COMMENTS:
INITIALS STATING YOU HAVE READ AND AGREE WITH THE ABOVE INFORMATION
I state that all the information I have given is true, and that I
understand that I will be notified in 3-5 buisness days if I am approved for adoption.
.
Signature or initials:Date:
