Adoption Application Form
Please fill in its entirety. Thank you!
Pet(s) of interest: *
Your answer
Why are you interested in adopting this pet or pets? *
Your answer
Is this pet for you or someone else? *
Your answer
Full Name *
Your answer
Name of other adult in household and relationship: *
Your answer
Address / City / State / Zip *
Your answer
Contact Phone: *
Your answer
Contact Email: *
Your answer
Occupation / Employer *
Your answer
Number of adults living in home: *
Your answer
Number of children living in home, part or full time: *
Your answer
Names and ages of children, if applicable:
Your answer
Are you serving in the military or plan to serve?
If Yes, who will care for your pet while you are deployed?
Your answer
Reference Name 1 / Phone *
Your answer
Reference Name 2 / Phone *
Your answer
Type Of Dwelling: *
Own or Rent? *
If you rent, please provide landlord's name and phone:
Your answer
If you have a yard, how high is your fence? *
Your answer
Do you have a pool? *
Is the pool area fenced?
Are you planning to move in the near future? *
** Pets you currently have at home **
How many pets do you currently have? *
Your answer
Has your dog been tested for Heartworm? If so, what was the result? *
i.e.: N/A, Yes - positive, Yes - negative, No, etc.
Your answer
Has you cat been tested for FIV and Feline Leukemia? If so, what was the result? *
i.e.: N/A, Yes - FIV positive, Yes - both positive, Yes - negative, No, etc.
Your answer
Pet's name(1) / breed / sex / approximate age:
Your answer
Spayed / Neutered(1)?
Type of animal(1)
Where did you obtain this pet(1)?
Your answer
How Many Years Did You Have This Pet(1)?
Your answer
Pet's name(2) / breed / sex / approximate age:
Your answer
Spayed / Neutered(2)?
Type of animal(2)
Where did you obtain this pet(2)?
Your answer
How Many Years Did You Have This Pet(2)?
Your answer
Pet's name(3) / breed / sex / approximate age:
Your answer
Spayed / Neutered(3)?
Type of animal(3)
Where did you obtain this pet(3)?
Your answer
How Many Years Did You Have This Pet(3)?
Your answer
** Pets you have previously owned **
Pet's name(1) / breed / sex / approximate age:
Your answer
Type of animal(1)
Where did you obtain this pet(1)?
Your answer
How Many Years Did You Have This Pet(1)?
Your answer
What happened to this pet(1)?
Your answer
Pet's name(2) / breed / sex / approximate age:
Your answer
Type of animal(2)
Where did you obtain this pet(2)?
Your answer
How Many Years Did You Have This Pet(2)?
Your answer
What happened to this pet(2)?
Your answer
Family Vet Name, Current Or Previous: *
Your answer
Family Vet Phone: *
Your answer
Do We Have Permission To Contact Your Veterinarian As Reference? If No, Please Explain: *
Your answer
Who Would Be Responsible For The Care Of The Pet? *
Your answer
What Is Your Primary Reason For Adopting'a Pet? *
Your answer
Where would the pet sleep? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
Your answer
How Many Hours Per Day Would The Pet Be Left Alone? *
Your answer
Where would the pet be left when left alone? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
Your answer
When you're at home, where the pet would be? *
i.e: Outside, Inside, Yard, Basement, Bedroom, etc...
Your answer
Are there any areas that are off limits? *
Your answer
When you travel, who will care for your pet while you're gone? *
Your answer
Do you have a dog door or plan to install one? *
If adopting a cat, are you planning to declaw? *
Under what circumstances would you not keep the pet? *
i.e.: moving, new born baby, pet illness, family illness, adopting a new pet, etc.
Your answer
If the pet becomes ill or injured, are you financially prepared to provide medical care? *
A pet may live 10 to 15 years or more. What would you do with your pet if you could no longer care for the pet? *
Your answer
Is there anything else you would like to tell us about yourself?
Your answer
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