Adoption Application Form
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Pet(s) of interest: *
Why are you interested in adopting this pet or pets? *
Is this pet for you or someone else? *
Full Name *
Name of other adult in household and relationship: *
Address / City / State / Zip *
Contact Phone: *
Contact Email: *
Occupation / Employer *
Number of adults living in home: *
Number of children living in home, part or full time: *
Names and ages of children, if applicable:
Are you serving in the military or plan to serve?
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If Yes, who will care for your pet while you are deployed?
Reference Name 1 / Phone *
Reference Name 2 / Phone *
Type Of Dwelling: *
Own or Rent? *
If you rent, please provide landlord's name and phone:
If you have a yard, how high is your fence? *
Do you have a pool? *
Is the pool area fenced?
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Are you planning to move in the near future? *
** Pets you currently have at home **
How many pets do you currently have? *
Has your dog been tested for Heartworm? If so, what was the result? *
i.e.: N/A, Yes - positive, Yes - negative, No, etc.
Has you cat been tested for FIV and Feline Leukemia? If so, what was the result? *
i.e.: N/A, Yes - FIV positive, Yes - both positive, Yes - negative, No, etc.
Pet's name(1) / breed / sex / approximate age:
Spayed / Neutered(1)?
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Type of animal(1)
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Where did you obtain this pet(1)?
How Many Years Did You Have This Pet(1)?
Pet's name(2) / breed / sex / approximate age:
Spayed / Neutered(2)?
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Type of animal(2)
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Where did you obtain this pet(2)?
How Many Years Did You Have This Pet(2)?
Pet's name(3) / breed / sex / approximate age:
Spayed / Neutered(3)?
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Type of animal(3)
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Where did you obtain this pet(3)?
How Many Years Did You Have This Pet(3)?
** Pets you have previously owned **
Pet's name(1) / breed / sex / approximate age:
Type of animal(1)
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Where did you obtain this pet(1)?
How Many Years Did You Have This Pet(1)?
What happened to this pet(1)?
Pet's name(2) / breed / sex / approximate age:
Type of animal(2)
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Where did you obtain this pet(2)?
How Many Years Did You Have This Pet(2)?
What happened to this pet(2)?
Family Vet Name, Current Or Previous: *
Family Vet Phone: *
Do We Have Permission To Contact Your Veterinarian As Reference? If No, Please Explain: *
Who Would Be Responsible For The Care Of The Pet? *
What Is Your Primary Reason For Adopting'a Pet? *
Where would the pet sleep? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
How Many Hours Per Day Would The Pet Be Left Alone? *
Where would the pet be left when left alone? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
When you're at home, where the pet would be? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
Are there any areas that are off limits? *
When you travel, who will care for your pet while you're gone? *
Do you have a dog door or plan to install one? *
If adopting a cat, are you planning to declaw? *
Will your cat be: *
Under what circumstances would you not keep the pet? *
i.e.: moving, new born baby, pet illness, family illness, adopting a new pet, etc.
If the pet becomes ill or injured, are you financially prepared to provide medical care? *
A pet may live 10 to 15 years or more. What would you do with your pet if you could no longer care for the pet? *
Is there anything else you would like to tell us about yourself?
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