Sioux City Animal Adoption & Rescue Center
Pre-Adoption Questionnaire & Application
Name Of Pet That You Are Interested In:
Kennel Number:
Your Name:
First Name
Last Name
Spouse / Partner Name:
First Name
Last Name
Your Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Email:
example@example.com
Phone Number:
-
Area Code
Phone Number
Name & Ages Of Anybody Under The Age Of 21 Who Live At The Above Address:
Are You Adopting The Pet For:
Yourself
Somebody Else
If For Somebody Else, Are They Aware Of Your Intent?
Yes
No
Have You Ever Adopted A Pet From Us Or Any Other Rescue Previously?
Yes
No
If Yes, Do You Still Have The Pet?
Yes
No
If No, - Why Not?
Are You Financially Able To Provide Food & Medical Care For Your New Pet?
Yes
No
Are You Financially Able To Spay or Neuter Your Pet As Required By Law? (If Not Already Done)
Yes
No
What Type Of Home Do You Live In?
House
Apartment
Condo
Other
If "Other" - Please Explain:
Do You:
Own Your Home?
Rent Your Home?
Live With Room Mate or Parents?
If You Rent Your Home, Are You Allowed To Have Animals?
Yes
No
If Applicable, Could You Provide Either A Note From Your Landlord Or Your Lease Agreement - To Prove That You Are Allowed To Have Pets?
Yes
No
Not Applicable
Landlords Name:
First Name
Last Name
Landlords Phone Number:
-
Area Code
Phone Number
Do You Have A Fenced-In Yard?
Yes
No
If Yes, How Tall Is The Fence?
Would You Allow A Home Inspection By Animal Control Or A Volunteer?
Yes
No
Do You Have Other Cats Or Dogs At The Moment?
Yes
No
If Yes - How Many?
What Breed(s)? How Old? Fixed?
Have You Had A Cat Or Dog In The Past?
Yes
No
If Yes And You No Longer Have Him or Her - Why Not?
Have You Ever Had To Surrender A Pet To A Rescue Facility / Shelter?
Yes
No
Who Would Be Responsible For Your New Pet?
Reason For Wanting To Adopt A New Pet?
Family Pet
Hunting
Fishing
Service Pet
Other
What Would You Do If You Had To Move?
Could Anything Happen That Would Want You To Give Up This Pet?
Yes
No
If Yes, Select All Possible Reasons For Giving Up This Pet:
Divorce
Illness
Moving
New Baby
New Job
House Training
Shy
Chewing
Barking
Digging
Aggressive
Allergies
Shedding
Too Big
Gets Ill / Sick
Pets Not Getting Along
Not Obedient Enough
Any Other Reason?
Anything Else That You Would Like Us To Take Into Consideration When Evaluating This Application? If Yes, Please Describe:
All Of The Information That I Have Provided On This Questionnaire Is True And Accurate And If Any Of The Information Changes, I Will Advise You Promptly. (please print your name to sign)
Today's Date:
Submit
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