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Adoption Application Form
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* Indicates required question
Email
*
Your email
First Name
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Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Address
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Your answer
City
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Your answer
Zip Code
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Your answer
Phone (Please specify home or cell) Ex: Cell 876-345-2928
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Your answer
County
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Your answer
Date of Birth
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MM
/
DD
/
YYYY
Are you a student?
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Yes
No
Do you own or rent?
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Own
Rent
How long have you lived at this current address?
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Your answer
If renting, what is your Landlord's name and phone number? *You must have permission from landlord or leasing company to have a pet.
Your answer
Type of residence?
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House
Apartment
Condo
Mobile Home
Please provide the full name and DOB of any other adults living in your house.
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Your answer
Please provide the name and ages of any children living at your home.
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Your answer
What pet are you interested in adopting?
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Dog
Cat
Do you have a specific animal in mind? If not what are your breed/age/gender preferences?
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Your answer
Which best describes the activity level in your home?
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Quiet
1
2
3
4
5
Very Active
Please tell us about each pet living in your home. Name, Type, Breed, Age, M/F, Spayed/Neutered?
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Your answer
Are your pets up to date on shots and heart-worm preventative?
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Your answer
Please provide the following information about the vet/vets caring for your current/past pets: Clinic name, City/State, Phone number
NOTE: Please do not list Ambassadors or other vaccination clinics as a vet reference. While they do provide similar services, they are not a vet that can confirm medical history such as prevention and surgery.
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Your answer
Whose name are the vet records under?
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Your answer
Please tell us about any pets you have had in the last five years that are no longer living with you. (Name/type of pet-euthanized, gave away, old age, etc.)
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Your answer
Please provide the name, relationship (boss/friend/coworker etc.), and phone number of 3 references. The references should not be related to you OR live with you.
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Your answer
I understand that Ambassadors for God's Creatures ( "AGC") will contact the veterinarian(s) I have listed on this form. By providing AGC with my veterinarians' information, I am allowing AGC to contact my veterinarian(s) and authorize the release of information to AGC.
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Yes
No
I accept that if my application should be denied, I may or may not be given full disclosure for the reason for the denial.
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Yes
No
By entering my name below and submitting this application, I certify that the information I have provided on my application is true and correct. If I fail to complete required information, my application may be voided.
*
Your answer
Send me a copy of my responses.
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