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Adoption Form
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Name
*
First
Last
Date
Breed/Age
Or enter name of or description of the animal you are interested in adopting,
Home Phone
*
Work Phone
Age of applicant
*
Email
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Do you live in.
*
House
TownHouse
Apartment
Condo
Duplex
Mobile
Do you
Rent
Own
Other
How long at this address?
*
Do you live with your parents ?
No
No
Yes
** YOU MUST PROVIDE THE NAME AND PHONE NUMBER OF YOUR LANDLORD OR CONDO ASSOC. WITHIN 24 HOURS OR WE WILL MOVE ON TO THE NEXT APPLICANT.
Landlord's name
Landlord's Phone
Applicant's Employer
*
How Long Employed?
*
Does anyone in your home have allergies to animals?
No
No
Yes
Does anyone have asthma?
No
No
Yes
Do you have a TOTALLY fenced in yard?
No
No
Yes
Size of your yard:
Type of Fence:
Height of Fence:
Where will the pet be kept during the DAY?
Inside
Inside
Outside
Other
Where will pet be kept during the NIGHT?
Inside
Inside
Outside
Other
If the Answer above is "INDOORS" where during the day and night?
INSIDE - DAY
(ie: Garage, Bedroom, Run of the House, Finished basement, Unfinished Basement, etc.)
INSIDE - NIGHT
(ie: Garage, Bedroom, Run of the House, Fnished basement, Unfinished Basement, etc.)
During Routine Absences
(ie: errands, work)
Do you have a
PET DOOR
DOG HOUSE
CRATE
KENNEL RUN
TIE-OUT STAKE
OTHER
How many ADULTS live in your home?
How many CHILDREN live in your home?
Ages of children living in your home
Do children frequently visit & if so , what are their ages
Is anyone home during the day? how long?, Who?
Can they handle the animal you want to adopt?
No
No
Yes
Unsure
ALL MEMBERS OF THE HOUSEHOLD, INCLUDING PETS, MUST VISIT WITH THE ANIMAL BEFORE THE ADOPTION IS APPROVED.
How many hours will the pet be without humans each day?
Who will be the primary care giver?
Who will care for your animal while you are on vacation?
What will you do with animal if you move?
Are you willing and able to provide pet care for the next 10 or more years, including vet checks, vaccinations, boarding, medical care, indoor housing etc.?
No
No
Yes
Unsure
What do you think pet care costs per year, including annual vaccinations, food, toys, minimal ordering, grooming, etc.?
Are you willing and able to support a pet?
No
No
Yes
Unsure
We require all animals adopted fromus to be spayed or neutered. Do you have any questions or reservations about this policy?
No
No
Yes
Unsure
Please list all pets you have owned in the past 10 years. If none, then include pets owned in your childhood (clearly indicate between childhood pet & pet as an adult). Include any pets residing in your home but which you do not own.
Owned Pet 1
Breed / Gender / Age / Spayed Neuterd / What Happened to Pet
Owned Pet 2
Breed / Gender / Age / Spayed Neuterd / What Happened to Pet
Owned Pet 3
Breed / Gender / Age / Spayed Neuterd / What Happened to Pet
Owned Pet 4
Breed / Gender / Age / Spayed Neuterd / What Happened to Pet
Owned Pet 5
Breed / Gender / Age / Spayed Neuterd / What Happened to Pet
How long did you own the above listed pets?
If deceased, how old was your pet when it died and explain details of death.
If you have ever had a pet lost, disappear or die at an early age, please provide details dogs dying before 10 or cats before 14 years of age:
Have you ever sold, given away or surrendered a pet? (explain)
How do you plan to exercise your dog?
Who will supervise outdoor activites?
How will the dog be confined outdoors during exercise?
Have you ever trained a dog?
Yes
Yes
No
Have you ever Crate-trained a dog?
Yes
Yes
No
Are you willing to give this pet time to adapt to it's new environment and family members?
Yes
Yes
No
SOME PETS MAY TAKE 30 DAYS OR LONGER TO ADJUST.
This animal may not be housebroken. Are you willing to take the time to work with animal?
Yes
Yes
No
Under what circumstance(s) would you surrender this pet?
Past Veterinarian's name:
*
First
Last
Past Veterinarian's phone number:
Name of pets treated:
Intended Veterinarian:
How did you hear about us / Who referred you?
A rescue Representative will conduct a formal interview with you and your family prior to adoption.
This interview is to answer any questions about your new pet and to alert you to problems that may arise.
The rep will help you plan how to successfully introduce your new pet to your new home and to explain how to help your new pet become part of the family.
I certify that I have answered all questions honestly and to the best of my ability. I understand that any misrepresentations of fact may result in removal of adopted pet from my home.
*
Yes
Electronic signature
Clear Signature
Date
Captcha
*
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