Adoption Application

Adoption Application

Utah Animal Advocacy Foundation
Date
Name of animal you are interested in adopting*
Is this animal a dog or a cat?*

DogCat
Full Name*

First NameLast Name
Birth Date

MonthDayYear
Cell Phone*

Area CodePhone Number
Home/Work Phone

Area CodePhone Number
Does this phone receive text messages?
Spouse/Partner's Name

First NameLast Name
Birth Date

MonthDayYear
Spouse/Partner - Home/Cell Phone

Area CodePhone Number
Does this phone receive text messages?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address, if different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
Do you prefer to receive calls, texts, or emails?

CallTextEmail
Ages of Children in the home
Ages of children that visit regularly
Is it likely that you will have children living with you in the next 10 to 15 years? Please explain.
Please list all persons living in your home, part or full time, who are not listed above
Does anyone in the home have allergies to dogs or cats? If so, who?
This pet is for:

MeMy familyMy child/childrenMy parentsFriendOther
What types of pets have you/your family owned?

DogsCatsSmall animalsOther
Do you currently have any pets?

YesNo
If yes, please list Type/Breed, Age, Indoor/Outdoor, How long it has been with you:
My Cat(s) is/are:

Spayed or NeuteredDeclawedCurrent on vaccinesTested for FIVTested for Feline Leukemia
My Dog(s) is/are:

Spayed or NeuteredCurrent on vaccinesObedience trained
Who is your veterinarian or Veterinarian Clinic?
How long have you used this vet?
The average annual cost for veterinary care for a pet is between $500 and $1000 which includes vaccines, annual exam, and possible health or emergency care. Are you in a position to assume these costs for the life of the pet?

YesNo
Please provide an accurate history of pets you have had in the past (pets growing up to most recent), including type, how long you had them, and why they are no longer with you. This must be completed. *
Have you ever been approved to adopt from another rescue organization?

YesNo
If yes, which one?
Have you ever given a pet to a shelter or humane society?

YesNo
If yes, please explain
Have you ever had a pet euthanized?

YesNo
If yes, please explain
Do you:

OwnRentLive with parentsOther
Do you live in a(n):

HouseApartmentDuplexCondoMobile HomeOther
How long have you been at this address?
Is it likely you will move in the next 10 to 15 years?

YesNo
If yes, please explain
If you rent, does your landlord allow pets?

YesNo
Is a pet deposit required?

YesNo
If yes, how much is the deposit?
Are there any restrictions (i.e. number of pets, size/ weight, etc)?

YesNo
Landlord's Name
Landlord's Phone #

Area CodePhone Number
Are you willing to have a representative from UAAF do a home visit?

YesNo
Why do you want to adopt a pet? Please check all that apply.

House petCompanion for selfCompanion for childCompanion for other petPersonal protectionBarn cat/mouserOther
Why do you want to adopt this particular pet?
How many hours per day will the pet be left alone (without human companionship)?
Who will be responsible for the daily care of this animal?
Do you have a dog door?

YesNo
Would the pet have access to the dog door when you are not home?

YesNo
Do you have any concerns about the new pet getting along with your current pet(s)? Please explain.
Do you feel you can commit to the care of this pet for the rest of its life (10 to 20 years)?

YesNo
Under what circumstances would you consider selling, trading, or giving away your pet?
Which of the following behavior issues do you feel you would be willing/able to deal with?

ChewingFence jumpingBarking/whiningAggression toward other animalsFearful or shy behaviorHousebreaking problemsNipping or bitingSeparation anxietyScratching of carpet or furniture
If you are interested in adopting a CAT:
Will the cat be:

IndoorOutdoorIndoor/Outdoor
What are your views on declawing?
Where will the litter box be kept?
If you are interested in adopting a DOG:
Where will the dog be kept when you are home?
Where will the dog be kept when you are out?
Do you have a securely fenced BACK yard?

YesNo
Fencing material
Height
Do you have a securely fenced FRONT yard?

YesNo
Fencing material
Height
How will you exercise your dog?
Are there times when the dog will be tied up?

YesNo
If yes, when?
Will the dog be allowed to ride in the back of a pick-up truck?

YesNo
If yes, is there a shell?

YesNo
If your new dog/puppy is not housebroken, what method will you use to train it?
Would you be willing to take the dog to obedience training should the need arise?

YesNo
References (please provide all requested information as UAAF will need this to register your new pet's microchip)
Your place of employment*
Phone Number

Area CodePhone Number
How long have you been employed there?*
Spouse/Partner's place of employment
Phone Number

Area CodePhone Number
How long have they been employed there?
Name of nearest relative*
Relationship*
Phone Number*

Area CodePhone Number
Personal reference*
Relationship*
Phone Number*

Area CodePhone Number
How did you hear about us?*
I, the undersigned, certify that all statements and answers are true and complete. I understand that any untrue statement is deemed reason for refusal of adoption or reclaiming of any adopted pet.
Name*
Date*
Should be Empty:

Adoption Application

If you are interested in adopting a CAT:

If you are interested in adopting a DOG:

References (please provide all requested information as UAAF will need this to register your new pet's microchip)

I, the undersigned, certify that all statements and answers are true and complete. I understand that any untrue statement is deemed reason for refusal of adoption or reclaiming of any adopted pet.