North Jersey Community Animal Shelter - Adoption Application
23 Brandt Lane Bloomingdale, NJ 07403 
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Name: First and Last *
Email: *
Address: (City, State, Zip) *
Cell Phone: *
Home Phone: (if applicable)
Employer: *
Position: *
Years There: *
What type of pet are you looking for?  *
Is there a specific pet from our shelter you were looking at?
What breeds are you familiar with?  *
How long have you been looking for this type of pet? *
Is this pet a gift? If yes, for whom? 
 *
How many adults live in household?  *
How many children live in household?  *
Ages of all children (including adult children) living at household?  (if applicable)
Do all members of your household want this pet?  *
Do any family members have allergies? 
If Yes, please explain.
 *
Who will be primarily responsible for the pet?  *
What type of home do you live in? *
Do you Rent or Own? *
If renting: 

Landlord's name, phone number and best time to call.

Does your yard have a fence? *
If yes, how high? 
Type of Fence (if applicable)
Please explain how and when you will exercise the pet and allow it to relieve itself:  *
Where will this pet to be kept?  *
What pets have you owned in the past? *
Where are they now?
What pets do you own now? 
 *
Where are they kept?
Are they spayed or neutered?
Are their vaccinations and licenses current? (if applicable)

★ Before adopting a new pet, NJCAS recommends having all dogs in your household vaccinated against Distemper and Bordetella. Failure to do so is at your own risk.
★ Note : Local laws require all pets over 6 months of age to be vaccinated against Rabies andlicensed with their town.
How long will the pet be left alone each day? 
 *
Where will the pet be kept during this time?  *
Where will the pet sleep? *
How many hours will the pet be allowed to play outside?  *
What will you do if the pet gets lost?  *
What will you do if your pet becomes ill and requires expensive medical care?  *
What will you do with your pet when you go on vacation?  *
What will you do with your pet if you move?  *
What will you do if your pet chews furniture or displays other destructive behavior?  *
Are you familiar with: (Choose all that apply) *
Required
Have you ever participated in a formal pet obedience training class?  *
Are you willing to seek professional help if behavioral issues arise in this pet?  *
Name and telephone of your veterinarian:  *
Please provide one personal contact who can recommend you as a responsible pet owner.

(Name, Phone Number and Relationship)
 *
Please provide emergency contact NOT living in your home.

(Name, Phone Number and Relationship)
 *
Please provide the name of the person that will take care of this pet if you are no longer able.

(Name, Phone Number and Relationship)
 *
Will you allow us to make a home visit to verify your application? *
Oh are you willing to agree to a 3 month, 6 month, and yearly follow up visit. *
Please add any additional information that you think we should know about.
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