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.

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

This is a required question

Pet Your Are Interested In

Pet's Name

This is a required question

Breed

This is a required question

Type

Dog
Cat

This is a required question

Gender

Female
Male

This is a required question

Age

This is a required question

About The Applicant

First Name

This is a required question

Last Name

This is a required question

Email

This is a required question

Primary Phone

000-000-0000

This is a required question

Secondary Phone

000-000-0000

This is a required question

Address

This is a required question

City

This is a required question

State

This is a required question

Zip

This is a required question

County

This is a required question

Employed?

Yes
No

This is a required question

Employer

This is a required question

Occupation

This is a required question

Work Phone

This is a required question

Student?

Yes
No

This is a required question

References

(Only one may be a relative)

Full Name (Ref 1)

This is a required question

Phone (Ref 1)

This is a required question

Relationship (Ref 1)

This is a required question

Full Name (Ref 2)

This is a required question

Phone (Ref 2)

This is a required question

Relationship (Ref 2)

This is a required question

Housing Detail

Type of Housing

House/Townhouse
Apartment/Duplex
Live with Parents
Other:

This is a required question

Do you Rent or Own?

Rent
Own

This is a required question

Landlord's Full Name

This is a required question

Landlord's Phone

This is a required question

Number of adults in the home

This is a required question

Number of children in the home and ages

This is a required question

Has anyone in the home been convicted or charged of a crime related to violence?

Yes
No

This is a required question

Experience with Pets Without Parents

Have you ever filled out an adoption application with Pets Without Parents?

Yes
No

This is a required question

If "Yes," when did you fill one out?

This is a required question

Have you ever adopted from Pets Without Parents?

Yes
No

This is a required question

If "Yes," when did you adopt?

This is a required question

Who did you adopt?

This is a required question

How did you hear about Pets Without Parents?:

This is a required question

Current Pets in Home

Name (Pet 1)

This is a required question

Breed (Pet 1)

This is a required question

Age (Pet 1)

This is a required question

Type (Pet 1)

Dog
Cat

This is a required question

Spayed or Neutered? (Pet 1)

Yes
No

This is a required question

Vaccinations Current? (Pet 1)

Yes
No

This is a required question

How long have you owned this pet? (Pet 1)

This is a required question

Name (Pet 2)

This is a required question

Breed (Pet 2)

This is a required question

Age (Pet 2)

This is a required question

Type (Pet 2)

Dog
Cat

This is a required question

Spayed or Neutered? (Pet 2)

Yes
No

This is a required question

Vaccinations Current? (Pet 2)

Yes
No

This is a required question

How long have you owned this pet? (Pet 2)

This is a required question

Name (Pet 3)

This is a required question

Breed (Pet 3)

This is a required question

Age (Pet 3)

This is a required question

Type (Pet 3)

Dog
Cat

This is a required question

Spayed or Neutered? (Pet 3)

Yes
No

This is a required question

Vaccinations Current? (Pet 3)

Yes
No

This is a required question

How long have you owned this pet? (Pet 3)

This is a required question

Name (Pet 4)

This is a required question

Breed (Pet 4)

This is a required question

Age (Pet 4)

This is a required question

Type (Pet 4)

Dog
Cat

This is a required question

Spayed or Neutered? (Pet 4)

Yes
No

This is a required question

How long have you owned this pet? (Pet 4)

This is a required question

Vaccinations Current? (Pet 4)

Yes
No

This is a required question

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.

This is a required question

Where do these pets stay during the day?

This is a required question

Where do these pets stay at night?

This is a required question

Pets You Have Owned in the Last Five Years

(Not including current pets in home)

Name (Prev 1)

This is a required question

Type (Prev 1)

Dog
Cat

This is a required question

When and why did this relationship end? (Prev 1)

This is a required question

Name (Prev 2)

This is a required question

Type (Prev 2)

Dog
Cat

This is a required question

When and why did this relationship end? (Prev 2)

This is a required question

Name (Prev 3)

This is a required question

Type (Prev 3)

Dog
Cat

This is a required question

When and why did this relationship end? (Prev 3)

This is a required question

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.

This is a required question

Have you ever given up on a pet?

Yes
No

This is a required question

Under what circumstances?

This is a required question

Veterinary Information

Current or Previous Veterinarian

This is a required question

Veterinarian Phone

This is a required question

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.

This is a required question

Care of Your New Pet

Do you intend to breed this pet?

Yes
No

This is a required question

Do you have a fenced yard?

Yes
No

This is a required question

Do you own a crate?

Yes
No

This is a required question

Where will your pet stay during the day?

This is a required question

How long will your new pet be alone during the day (# of hours)?

This is a required question

Where will your new pet sleep at night?

This is a required question

Per year, how much do you expect veterinary costs to be?

This is a required question

Can you/will you afford an average of $500 in vet expenses should this pet become ill?

Yes
No

This is a required question

Do you anticipate any major changes in the next year (moving, new baby, etc.)?

Yes
No

This is a required question

If "Yes," please provide details.

This is a required question

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

This is a required question

If Adopting a Dog

How will you deal with behavioral issues that may arise with your new dog?

This is a required question

Do you expect your new dog to have accidents in the house, even if it's housebroken?

Yes
No

This is a required question

If Adopting a Cat

How will you prevent your new cat from scratching furniture, etc?

This is a required question

Will you let your new cat outside, and under what circumstances?

This is a required question

Do you intend to declaw your cat?

Yes
No

This is a required question

Additional Comments

Additional Comments

Provide any pet details or other information that you think would help us process your application.

This is a required question

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

This is a required question

Date

(MM/DD/YYYY)

This is a required question