Applicant's Name:
Physical Address:
City:
State:
Zip Code:
Home Phone #:
Cell #:
In what type of housing do you reside?
Do you rent this property?
If you rent - Landlord's Name:
Landlord's Phone #:
Do you plan on moving in the next 12 months?
If yes, what do you plan to do with the animal?
Why do you want to adopt this pet? (Check all that apply)
If other, please explain.
Have you previously owned pets?
List all current pets here. Please list name, breed, sex, have they been spayed/neutered?, and are they are current on vaccinations?
Current veterinarian's name and phone #:
May we contact your veterinarian?
Are there any children in your household or children who visit frequently?
If yes, what are their ages?
In general, what types of discipline/corrections do you use with a pet?
Will you be using a crate for the purpose of training?
Do you have a fenced yard?
If yes, how tall is the fence and what type material?
What percentage of the time will the animal spend indoors and outdoors?
When the pet is outdoors, how will he/she be kept? (fence, chain, kennel, etc.)
In general, how many hours will this pet be left alone during the course of the day?
Where will this pet be kept while you are away from home during the day?
If other, please explain:
Where will this pet be kept while you are out of town?
Are you willing to provide the pet with monthly heartworm prevention medicine at your own expense?
Are you willing to provide the pet with yearly vaccinations at your own expense?
Who will be responsible for all medical costs?
List any characteristics of an animal that would NOT fit with your family or lifestyle:
Please include any information you would like for us to consider when reviewing your adoption application for approval:
Which pet(s) are you considering?
By signing this application, I declare that all information I have provided is true and correct to the best of my knowledge and that any false information may result in the denial of my application. I also understand that: 1) All adoptions may be subject to a waiting period. 2) The pet must be spayed or neutered BEFORE you may take it home. 3) We cannot guarantee the health, age, breed, disposition, temperament, or health of any pet. 4) We reserve the right to refuse any adoption for any reason, with or without an explanation.
Signature (type your name):
Date:
