Pet Adoption Application

Procedure: *Completely fill out & sign application. *You will hear back within 7 days, or please assume your application was not selected. *For applications selected, a vet-check will be done, then a home visit made. *If the adoption is approved, an adoption contract will be completed, donation accepted, and then you take your new friend home.

Today's Date:*

Date

Applying to:*

FosterAdopt

Name of Pet(s) Applying for*

Breed/Type*

Applicant(s) Name:*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Place of Employment:*

Since (mo/yr)*

Email:*

example@example.com

Home Phone: *

Please enter a valid phone number.

Work Phone: *

Please enter a valid phone number.

1. Why do you want to adopt a pet?*

2. What do you think are the most important responsibilities in owning a pet?*

3. Please list any preferences (age, sex, breed, personality)*

4. Have you submitted an application with another organization for a pet at this time?*

YesNo

5. Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control facility?*

YesNo

If yes, please explain:*

6. Are you willing to take the time to housebreak a pet, and do you understand that changing a pet's environment may cause the pet to have accidents?*

YesNo

7. If a behavioral problem arises, what steps will you take to work on it?*

8. If you are applying for a pet who is not housetrained, how will you housetrain the pet?*

9. Does any member of the family have any allergies to animal?*

YesNo

If Yes, please explain:*

10. Describe the kinds of personal situation where you might have to return your adopted pet, i.e. job loss, children, move, marital change, etc.*

11. For whom are you adopting the pet?*

SelfGiftOther family member

12. How many people live in your home? *

13. Are there any children in the household?*

YesNo

If Yes, what are their ages?

14. Who will be responsible for feeding and taking the pet outside/cleaning litterbox? *

15. Who will take care of the pet in the absence of the primary caretaker?*

16. What reading and/or other steps have you taken to prepare for a new pet?*

17. Will you take obedience training? *

18. Will you be willing to obtain an appropriately sized, open-wire crate if recommended?*

YesNo

19. What kinds of animals have you owned? *

21.- Describe all those pets you currently own:

a. Name*

Type *

Age *

Sex*

Is the pet Spayed or Neutered?*

YesNo

Primarily Indoor or Outdoor? Explain:*

What year did you get the animal?*

How did you acquire the animal?*

Comments:*

b.- Name*

Type *

Age *

Sex*

Is the pet Spayed or Neutered?*

YesNo

Primarily Indoor or Outdoor? Explain:*

What year did you get the animal?*

How did you acquire the animal?*

Comments:*

If you own any additional pets, please provide their information:*

21.- Describe all pets you previously owned in the last 10 years:

a. Name*

Type *

Age *

Sex *

Was the pet Spayed or Neutered?*

YesNo

Primarily Indoor or Outdoor? Explain:*

What year did you get the animal?*

How did you acquire the animal?*

Year deceased (or last year you had pet)?*

Cause of death, or where pet is now (detail):*

b. Name*

Type *

Age *

Sex *

Was the pet Spayed or Neutered?*

YesNo

Primarily Indoor or Outdoor? Explain:*

What year did you get the animal?*

How did you acquire the animal?*

Year deceased (or last year you had pet)?*

Cause of death, or where pet is now (detail):*

If you owned any additional pets, please provide their information:*

22.- List each vet/animal hospital where your animal(s) received care over the last 10 years:
If several vets were used, please explain and provide approximate service dates. Please note that application review cannot be completed unless each vet's phone number is provided.

Type a question*

What owner name(s) are records listed under:*

Date of last vet visit: *

23. Name of vet you will use for your new pet: *

24. What kind of veterinary care do you plan to provide? *

25. Have you considered the extra expenses that will come with having a pet including vet care, food, supplies and equipment, toys, training and boarding? Please explain:*

26. What type of home do you live in?*

27. Do you own or rent your residence?*

OwnRent

28. If you rent: Landlord name

Landlord Phone #

Please enter a valid phone number.

What type/size pets are allowed?

If you have rented your current residence for under a year, please provide prior address and prior landlord contact phone number:

Prior Address:

Prior Landlord's name:

Landlord phone #:

29. Do you have a fenced yard?*

YesNo

Note: Secure, fully fenced yards are typically required for homes with children under age 12. For some dogs, fences of minimum 5 to 6 ft are required.

What type of fence?*

How tall? (Given range of heights, if relevant)*

Does the fence belong to you, or to neighbors?*

Any holes or gaps?*

YesNo

Is the fence attached to the home?*

YesNo

30. If you do not have a fence, do you plan to install a fence?*

YesNo

If Yes, when?

31. Describe the circumstances in which you would walk/exercise a dog on leash:*

32. Describe the circumstances in which you would walk/exercise a dog off leash:*

33. How often will you exercise the pet and for approximately how long?*

34. How many hours will the pet be left unattended (i.e., workday)?*

35. When you are home, where will the pet be kept?*

36. Where will the pet sleep?*

37. When no one is home (i.e., at work, shopping), where will the pet stay (be specific)? *

38. Have you used or do you plan to install a pet door?*

39. How often do you travel?*

40. What will you do with the pet when you travel?*

41. If you move, what will you do with the pet?*

42. Are you or your spouse with the military?*

YesNo

43. Are you aware CAC requires all dogs/cats in a home be spayed/neutered?*

YesNo

44. Are you aware of the adoption fee ($125 nonrefundable donation)?*

YesNo

45. Are you familiar with your local animal control laws?*

YesNo

46. Have all adult family members met with and agreed upon the pet? *

I have read above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Cloverleaf Animal Clinic reserves the right to annul the adoption and reclaim the animal. I give CAC permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on a mutually agreed date by a CAC volunteer before an adoption decision is made.

In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal, and other applications received on this animal. I understand it is CAC's prerogative to decide which home is most appropriate and that their decision is final, and therefore I will not argue with the decision. Unless otherwise indicated by CAC, I am free to apply and undergo the application process in the future.

Signature(s)*

Date*

Date

Printed Full Name(s)*