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Adoption Application
Bensonhurst Veterinary Care
Which cat are you hoping to adopt? *
Your Name: *
Primary Phone Number: *
Secondary Phone Number:
Email Address:
Preferred Method(s) of Contact
Date of Birth
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Place of Employment:
Position:
Work Schedule:
Please be as detailed as possible
Number of Adults (18 and older) living in your home: *
Please list first & last name(s) of housemate(s), as well as your relationship to them:
Number of children (under 18) living in the home full or part time: *
Age(s) of children:
Is everyone in your household aware of your intent to adopt a pet? *
Who will be the primary caregiver?
Will the pet live with you in your home, or with someone else?
Are you financially able to provide food, shelter, annual wellness care, and additional veterinary care in the case of unexpected injury or illness, and other pet-related expenses, if necessary for the animal you are hoping to adopt?
Clear selection
Is anyone in your household allergic to pets? *
Have you or anyone currently living with you ever been charged or convicted of animal neglect, cruelty/abuse or domestic violence? *
Have you ever been denied to adopt by another rescue organization or animal control shelter? *
If yes, please explain the circumstances:
Have you or any adult living with you ever had to surrender a pet to the humane society or animal control? *
If yes, please explain the circumstances:
Do you own a vehicle and do you drive regularly?
Clear selection
If no, how do you plan to get your new pet to the veterinarian if need be?
Have you ever owned a cat or dog before?
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How long has it been since you owned a pet?
What happened to the pet(s)?
Check all that apply.
Do you currently have a pet?
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How many cats, dogs, etc?
If you do currently have pets, please describe them in detail below.
Name, age, breed, length of time you've had in your house.
Are all present pets current on vaccinations?
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Are all spayed/neutered?
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If no, please explain:
Current Veterinarian's information:
Name, location, phone number. Please indicate if your current animals' records are under a different client name.
Please describe your home:
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How long have you lived at this address?
Do you rent the property or own it?
Is anyone else also listed as the property owner?
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If yes, please list their name(s) and relationship to the applicant:
If renting, please list your landlord's name/company and phone number:
When does your lease expire?
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If renting, does your lease specify that pets are allowed?
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How many pets are allowed?
Is there a deposit required?
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Amount per pet:
If you currently own a pet, has the deposit been paid?
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Are there any breed restrictions or weight limits?
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If yes, please explain:
Will the pet be primarily:
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Where will the pet be kept when you are not home?
How many hours will the pet be left alone for on a regular basis?
If you are experiencing behavioral or medical problems with your new pet, do you agree to contact BVC as soon as possible so that we can help you to address the issues? *
Bensonhurst Veterinary Care reserves the right to refuse adoption to anyone who has a history of neglect or displays lack of commitment to a pet, or to any applicant that does not appear to possess the criteria necessary for the particular pet which they are seeking to adopt. No animal will be adopted to an applicant who has provided false information on this adoption application. The right is also reserved for BVC to inspect the property where the animal will reside prior to the final adoption approval. *
I certify that the information above is true and correct to the best of my knowledge and by typing my full name below I authorize GVC to verify same.
Todayt's Date:
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Additional comments, questions, or concerns:
Please be as wordy as you'd like! We'd prefer to deal with any obstacles or potential issues right off the bat.
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