Adoption Application

Pet Adoption Application

General Information
Pet's name you wish to adopt:*
Name:*
Address:*
Home Phone:*
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Mobile Phone:*
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E-mail:*
Marital Status:*
Spouse's or Partner's name:*
Spouse or Partner's Mobile Phone Number:*
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Home Information
What type of Dwelling do you live in?*
Do you own or rent?*
Your landlord's name?*
Your landlord's phone number?*
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Does your landlord have any breed or size restrictions?*
What are the Restrictions?*
Yard Information
Do you have a yard?*
Is it completely fenced?*
Fence type?*
How high is your fence/gates at the lowest point?*
How high is your fence/gates at the highest point?*
Children Information
Are there, or will there be, any children living or staying in your home?*
How many children? *
Age(s) of the children in your home?*
What is the status of the children in your home?*
Other Resident Information
Are there, or will there be, anyone else living or staying in your home?*
What is the status of the residents in your home?*
How Many other residents?*
What relation are they to you?*
Medical Information
Does anyone in your household have allergies?*
What is/are the allergy/allergies?*
Employment, Reference, and Contact Information
Are you employed?*
Name of employer:*
Employer address:*
Employer phone:*
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Is your Spouse or Partner Employed?*
Spouse's or Partner's Employer?*
Spouse's or Partner's Employer Address?*
Spouse's or Partner's Employers Phone? *
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Contact Information
Non-Family Contact Name:*
Non-Family Contact Phone:*
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How long have you known him or her?*

Pet Information

Dog Information
Are there any dogs in your house or on your property?*
How many dogs do you have on your property?*
What is/are the/their breed(s), age(s), and sex(es) of the dogs?*
Are all of the dogs spayed or neutered?*
If the dogs are not all spayed or neutered, Why?*
Do any of the dogs have health or behavioral issues?*
If so, what health or behavioral issues do the dogs have?*
Cat Information
Are there any cats in your house or on your property?*
How many cats do you have on your property?*
What is/are the/their breed(s), age(s), and sex(es) of the cats?*
Are all of the cats spayed or neutered?*
If the cats are not all spayed or neutered, Why?*
Is/are the cats indoor, outdoor, or both?*
Do any of the cats have health or behavioral issues?*
If so, what health or behavioral issues do the cats have?*
Other Animal's Information
Do you have any other pets in your house or on your property, (i.e. birds, fish, rabbits, reptiles, etc..)?*
What species are they?*
How many of each species?*
Do you have any farm animals on your property, (i.e. chickens, horses, sheep, goats, etc..)?*
What species of farm animals are they?*
How many of each farm animal species?*
Veterinarian Information
Do you have Veterinarian?*
Veterinary Clinic Name:*
Veterinary Clinic Address:
Veterinary Clinic Phone:*
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Veterinarian's Email:
Miscellaneous Information
What is the longest period of time the pet will be alone?*
How often will this happen?*
Will you ever be transporting the dog in the back of an open pickup?*
What will happen to the pet if you relocate?*
Why did you choose this particular animal? *
Please check all that apply to your new animal:*
Additional Comments:
Date:*
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First & Last Name:*
Best Phone Number To Be Reached At?
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