Pets Without Parents Adoption Application
* Please answer each required question. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED! When finished, click the "SUBMIT" button at the bottom of the form.
* Please note that submitting an online application for a particular pet does not necessarily mean that pet will be placed on hold for you. A hold is issued on a "first come, first served" basis, and you will be assigned in the order received.
* In order for a pet to have the best chance of going home as soon as possible, please come into the shelter to meet the pet you are applying for to be sure it is the right fit for you. We cannot place long term holds on a pet.
* Once your application is approved and the pet has been spayed/neutered, you must complete the adoption by the next business day or your hold will be removed. Please understand that the sooner a pet is adopted and goes home, the sooner a cage frees up to save the life of another companion animal in need.
* Required
Certify Age
PLEASE NOTE: You must be at least 18 years of age to complete and submit this application. You may not complete this application for anyone other than yourself.
I certify that I am at least 18 years old AND that I am completing this application for myself.
*
Yes
No
Pet Your Are Interested In
Pet's Name
*
Your answer
Breed
*
Your answer
Type
*
Dog
Cat
Gender
*
Female
Male
Age
*
Your answer
About The Applicant
First Name
*
Your answer
Last Name
*
Your answer
Email
*
Your answer
Primary Phone
*
000-000-0000
Your answer
Secondary Phone
000-000-0000
Your answer
Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
County
*
Your answer
Employed?
*
Yes
No
Employer
Your answer
Occupation
Your answer
Work Phone
Your answer
Student?
*
Yes
No
References
(Only one may be a relative)
Full Name (Ref 1)
*
Your answer
Phone (Ref 1)
*
Your answer
Relationship (Ref 1)
*
Your answer
Full Name (Ref 2)
*
Your answer
Phone (Ref 2)
*
Your answer
Relationship (Ref 2)
*
Your answer
Housing Detail
Type of Housing
*
House/Townhouse
Apartment/Duplex
Live with Parents
Other:
Required
Do you Rent or Own?
*
Rent
Own
Landlord's Full Name
Your answer
Landlord's Phone
Your answer
Number of adults in the home
*
Your answer
Number of children in the home and ages
*
Your answer
Has anyone in the home been convicted or charged of a crime related to violence?
*
Yes
No
Experience with Pets Without Parents
Have you ever filled out an adoption application with Pets Without Parents?
*
Yes
No
If "Yes," when did you fill one out?
Your answer
Have you ever adopted from Pets Without Parents?
*
Yes
No
If "Yes," when did you adopt?
Your answer
Who did you adopt?
Your answer
How did you hear about Pets Without Parents?:
*
Your answer
Current Pets in Home
Name (Pet 1)
Your answer
Breed (Pet 1)
Your answer
Age (Pet 1)
Your answer
Type (Pet 1)
Dog
Cat
Clear selection
Spayed or Neutered? (Pet 1)
Yes
No
Clear selection
Vaccinations Current? (Pet 1)
Yes
No
Clear selection
How long have you owned this pet? (Pet 1)
Your answer
Name (Pet 2)
Your answer
Breed (Pet 2)
Your answer
Age (Pet 2)
Your answer
Type (Pet 2)
Dog
Cat
Clear selection
Spayed or Neutered? (Pet 2)
Yes
No
Clear selection
Vaccinations Current? (Pet 2)
Yes
No
Clear selection
How long have you owned this pet? (Pet 2)
Your answer
Name (Pet 3)
Your answer
Breed (Pet 3)
Your answer
Age (Pet 3)
Your answer
Type (Pet 3)
Dog
Cat
Clear selection
Spayed or Neutered? (Pet 3)
Yes
No
Clear selection
Vaccinations Current? (Pet 3)
Yes
No
Clear selection
How long have you owned this pet? (Pet 3)
Your answer
Name (Pet 4)
Your answer
Breed (Pet 4)
Your answer
Age (Pet 4)
Your answer
Type (Pet 4)
Dog
Cat
Clear selection
Spayed or Neutered? (Pet 4)
Yes
No
Clear selection
How long have you owned this pet? (Pet 4)
Your answer
Vaccinations Current? (Pet 4)
Yes
No
Clear selection
Additional Pets in Home
If you have more than four pets, please list the name, breed, age, type, spay/neuter status, vaccination status and time you have owned each pet.
Your answer
Where do these pets stay during the day?
Your answer
Where do these pets stay at night?
Your answer
Pets You Have Owned in the Last Five Years
(Not including current pets in home)
Name (Prev 1)
Your answer
Type (Prev 1)
Dog
Cat
Clear selection
When and why did this relationship end? (Prev 1)
Your answer
Name (Prev 2)
Your answer
Type (Prev 2)
Dog
Cat
Clear selection
When and why did this relationship end? (Prev 2)
Your answer
Name (Prev 3)
Your answer
Type (Prev 3)
Dog
Cat
Clear selection
When and why did this relationship end? (Prev 3)
Your answer
Additional Pets You Have Previously Owned
If you have owned more than three pets, please list the name, type, and reason why relationship ended for each pet.
Your answer
Have you ever given up on a pet?
*
Yes
No
Under what circumstances?
Your answer
Veterinary Information
Current or Previous Veterinarian
Your answer
Veterinarian Phone
Your answer
Additional Veterinary Information
If you've used a previous vet, or your pet records are under a different name than yours (spouse, parent, etc), please provide that information in the field below.
Your answer
Care of Your New Pet
Why do you want a pet? (Select all that apply)
*
Companion/Family Member
Gift
Watch Dog
To Breed
Mouser
Child's Pet
Friend for Other Pet
Other:
Required
Do you intend to breed this pet?
*
Yes
No
Do you have a fenced yard?
*
Yes
No
Do you own a crate?
*
Yes
No
Where will your pet stay during the day?
*
Your answer
How long will your new pet be alone during the day (# of hours)?
*
Your answer
Where will your new pet sleep at night?
*
Your answer
Per year, how much do you expect veterinary costs to be?
*
Your answer
Can you/will you afford an average of $500 in vet expenses should this pet become ill?
*
Yes
No
Do you anticipate any major changes in the next year (moving, new baby, etc.)?
*
Yes
No
If "Yes," please provide details.
Your answer
Your new pet could live for another 20 years. Do you understand the responsibility involved, and are you willing to make a lifelong commitment to this pet?
*
Yes
No
If Adopting a Dog
How will you deal with behavioral issues that may arise with your new dog?
Your answer
Do you expect your new dog to have accidents in the house, even if it's housebroken?
Yes
No
Clear selection
If Adopting a Cat
How will you prevent your new cat from scratching furniture, etc?
Your answer
Will you let your new cat outside, and under what circumstances?
Your answer
Do you intend to declaw your cat?
Yes
No
Clear selection
Additional Comments
Additional Comments
Provide any pet details or other information that you think would help us process your application.
Your answer
Affirmation
Pets Without Parents, Columbus relies on the information given above to be complete and accurate in order to act on your application in a timely manner. Any false statements, misrepresentations, inaccurate information, or failure to supply the data requested may serve as a rejection of your application. By selecting "I Agree", you are authorizing the use of any screening agencies to verify criminal history and validate the accuracy of all information recorded above, and you give Pets Without Parents, Columbus the right to call your references, landlord, and veterinarian. I also understand that this application will not be fully approved until I have come in to meet the pet and been interviewed by Pets Without Parents staff. Pets Without Parents, Columbus reserves the right to reject any application for any reason.
Agree or Disagree?
*
Agree
Disagree
Date
*
(MM/DD/YYYY)
Your answer
Submit
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