Form

PET Adoption Application
Name*
Address*
Home Phone*
Cell Phone
Email*
Employer*
Employer Address*
Employer Phone*
Pets owned now

Cat(s) Dog(s) Other
If you checked "other," list pets
How long have you owned these pets?
Why are you looking to adopt?*
Are there other decision-making adults in the household?*
Are all decision-making adults looking forward to this addition?*
Are there any children in the household?*
If you checked "yes", list ages of children

infant 1-3 yrs. 3-6 yrs. 6-10 yrs. 10-13 yrs. 13-15 yrs. 15-19 yrs.
If household member becomes allergic, explain what you will do*
Check all pet behaviors that you find intolerable*

elimination scratching biting hissing fear shyness vocalization none
Have you or would you ever declaw a cat, or debark a dog?*

yes no
If you checked "yes," please explain why
When you are out of town, who cares for your pets?*
May we contact your caregiver?*

yes no not applicable
Caregiver's name*
Caregiver's number:*
Veterinarian*
Vet's number*
Reference (family) name*
Reference number*
Reference (friend) name*
Reference number*
Have you ever adopted from a shelter or rescue?*

yes no
Have you ever returned a pet that you adopted or purchased?*

yes no not applicable
If you checked "yes, " explain the circumstances
Do you agree to pre- and post adoption home visits?*

yes no don\'t know
Do you agree to have unaltered pet spayed/neutered*

yes no I\'ll try
Do you agree to have all necessary vax, flea/worm treatments, annual vet visit, and all medical care necessary for optimal health and comfort?*

yes no I\'ll try
Which pet(s) are you interested in? Questions/comments?
Should be Empty:

PET Adoption Application