Pet Adoption Application Form
Questions marked by * are required.
1.
First Name: *
2.
Last Name: *
3.
Email: *
4.
Co-Applicant's Full Name:
5.
Street Address: *
6.
Town/City: *
7.
State: *
8.
Zip Code: *
9.
Occupation:
10.
Home Phone Number:
11.
Cell Phone Number:
12.
Work Phone Number:
13.
Best time and way to contact you: *
14.
Age of pet desired: *
15.
Is there a specific animal from our web site that you are interested in? *
16.
If specific animal desired please list by name as well as a brief description so your application can be forwarded to the appropriate foster parent.
17.
Why are you interested in this particular animal? Please be specific.
18.
Would you consider one with Special -Needs such as one who requires medication for a permanent but controlled condition?
19.
Would you accept a mixed breed cat /dog? *
20.
Desired Activity Level of Pet: *
21.
Desired Sex of Pet: *
22.
Age of self, and all family members in home: *
23.
Ages of family members who visit your home? *
24.
Does everyone in your home share your interest in adopting a pet? *
25.
Who is the new pet primarily for:
26.
Who will care for, train and exercise the dog? Or care for, train the cat? *
27.
Does anyone in your home have allergies? *
28.
If Yes, to what allergens?
29.
If someone in the household would develop allergies what would you do with the pet?
30.
May we visit your home prior to adoption approval? *
31.
If Yes, when? (best times/days for you) *
32.
Past Pet History: Please list all the pets you have owned in the past five years, if any. Pet #1: Name, Breed/species, Sex, Spayed/ Neutered, Age Years owned, Indoor or Outdoor Pet, Do you still own?, If not please explain why.
33.
Past Pet History: Pet #2: Name, Breed/species, Sex, Spayed/ Neutered, Age Years owned, Indoor or Outdoor Pet, Do you still own?, If not please explain why.
34.
Past Pet History: Pet #3: Name, Breed/species, Sex, Spayed/ Neutered, Age Years owned, Indoor or Outdoor Pet, Do you still own?, If not please explain why.
35.
Past Pet History: Pet #4: Name, Breed/species, Sex, Spayed/ Neutered, Age Years owned, Indoor or Outdoor Pet, Do you still own?, If not please explain why.
36.
Past Pet History: Pet #5: Name, Breed/species, Sex, Spayed/ Neutered, Age Years owned, Indoor or Outdoor Pet, Do you still own?, If not please explain why.
37.
Please provide the full name, address, and phone number of your current veterinarian:
38.
Where do you purchase heartworm preventive if not from your veterinarian and please describe in your own words what you know about heart worm preventative?
39.
Please identify any other veterinarians that you have used for the past three years:
40.
How long have you lived at your current address? *
41.
Do you own or rent? *
42.
Renters: Please provide Landlord's name and phone number:
43.
Do you have the permission of your landlord to have a dog? If so up to what size?
44.
Will the pet be an indoor or outdoor pet primarily?
45.
How long daily will the dog/cat be left alone (hours without humans)?
46.
Where will the dog/cat stay when you are away from the house or during the night?
47.
Dogs: are you familiar with use of a dog crate to train the pet during your absence/at night?
48.
Is your yard completely enclosed?
49.
Type of fence? (include Height, Width, and Length)
50.
Approximate size of pet’s yard area?
51.
Do all the gates have locks?
52.
Will dog be walked daily? If cat, petted/groomed?
53.
Where will the animal be exercised? Fenced yard/park/etc?
54.
Will the new pet be allowed to run free without supervision?
55.
Will your dog receive formal obedience training?
56.
Do your current animals get along with other animals?
57.
Have you ever owned a cat before? Was it declawed?
58.
Are you willing to allow up to 2 weeks for your pets to adjust to one another? *
59.
Are you aware that routine costs of maintaining a dog/cat can be $500 a year or more?
60.
Have you ever sold, given away, or surrendered a pet to a shelter? If yes please state why:
61.
Please list 2 personal references and contact information for them: *
62.
Have you ever given an animal away due to behavior issues?
63.
Please tell us why you want a dog/cat:
64.
Please tell us a little of your lifestyle, your family including any special activities in which your dog/cat would be included. (If you have any special requirements or requests for a dog, please let us know so that we can more carefully match a dog to your lifestyle)
65.
When you move, go on vacation, or evacuate due to a hurricane, what will you do with your dog/cat?
66.
Do you understand the state and local ordinances concerning licensing and/or leashing?
67.
Have you, or any member of your family/household been cited for leash law violations or cruelty to animals in the past? If YES please specify:
68.
I/we attest that the information provided on this application is true and accurate to the best of my/our knowledge. I/we also understand that completion and submission of this application does not guarantee adoption of a pet. Please type in your and Co-applicant's names and date: *