• Pet Adoption Application

    Cloverleaf Animal Clinic 749 North White Station • Memphis, TN 38122 (901) 682-5681

  • 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:*
     - -
  • Applying to:*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • 4. Have you submitted an application with another organization for a pet at this time?*
  • 5. Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control facility?*
  • 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?*
  • 9. Does any member of the family have any allergies to animal?*
  • 11. For whom are you adopting the pet?*
  • 13. Are there any children in the household?*
  • 18. Will you be willing to obtain an appropriately sized, open-wire crate if recommended?*

  • 21.- Describe all those pets you currently own:

  • Is the pet Spayed or Neutered?*
  • Is the pet Spayed or Neutered?*

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

  • Was the pet Spayed or Neutered?*
  • Was the pet Spayed or Neutered?*

  • 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.

  • 26. What type of home do you live in?*
  • 27. Do you own or rent your residence?*
  • Format: (000) 000-0000.

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

  • 29. Do you have a fenced yard?*

  • 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.

  • Any holes or gaps?*
  • Is the fence attached to the home?*
  • 30. If you do not have a fence, do you plan to install a fence?*
  • 42. Are you or your spouse with the military?*
  • 43. Are you aware CAC requires all dogs/cats in a home be spayed/neutered?*
  • 44. Are you aware of the adoption fee ($125 nonrefundable donation)?*
  • 45. Are you familiar with your local animal control laws?*

  • 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.

  • Date*
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  • Should be Empty: