Bellson Adoption Application

An adoption fee applies to partially cover the veterinary cost associated with treating the animal. The Fee can range depending on age of the animal fand includes spay/neutering, minimum of first round of vaccines, a Feline Leukemia/FIV/Heartworm check, fecal check, deworming, and a microchip.

Bellson Animal Hopital reserves thr right to refuse adoptions to anyone.

Please understand that completeing this application does not guarantee you will be approved. No animal will be adopted to prospective owners who mislead our staff or fil to provide accurate information on the adoption application.

Name of the Pet*

Name*

First NameLast Name

Age*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number (Mobile)*

Phone Number (Work)*

Phone Number (Home)*

E-mail*

example@example.com

If your job involves frequent travel, how will you arrange for care for this animal? *

In what type of home for you live?*

HouseTrailerApartmentOther

Do you?*

RentOwnLive with parent/friendsOther

If you rent or belong to homeowners association, have ou secured permission to have pet?*

YesNo

Please list your landlords name and phone number below. Please, add if you allow us to contact your landlors.

Many animals are abandoned or dropped off at animal shelters when their owners relocate. Are you prepared to take this pet with you when you move, even if you may be inconvenienced*

YesNo

How many adults are living in your home?*

How many children live in your home? Please include ages.*

How would you describe your household?*

QuietAverageHecticOther

Are you or anyone in your household allergic to animals?*

YesNo

If so, how do you intend to deal with this? *

Where does the pet stay (be confined) while you are out or will they be free roaming? *

Do you have other animals in your household currently?*

YesNo

Please list all current pets in the household, their breeds, genders, and ages. *

Are all of your pets spayed/neutered and in good health?*

YesNo

If you have other cats, have they been tested for FIV/FeLeuk tested?*

YesNo

If so, results?*

PositiveNegative

Do you have a regular veterinarian ?*

YesNo

Name of Animal Clinic *

Clinic's Telephone*

Do we have permission to contact your vet?*

YesNo

Have you ever relinquished a pet to a shelter or vet clinic, if so, what were the circumstances? *

If adopting a kitten from us, do you plan on declawing them?*

YesNoUnsure at this time

Where will you primarily be keeping them?*

Inside homeOutsideKennelOther

Are you willing to spend the time and effort to help this pet adjust to your home and lifestyle?*

YesNo

Under what circumstances would you not keep this pet? *

Do we have permission to visit your home?*

YesNo

Do you have any questions about this pet for one of our staff members?

If you have not previously had pets or did not list a vet above, please list the name and phone number of one person, preferably not a family member, who can vouch for your suitability as a pet parent. *

Thank you for your interest, and taking the time to fill out this application. By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet and nullification of any contract in the future. I understand that Bellson Animal Hospital has the right to deny my request to adopt an animal. I authorize investigation of all statements in this application. This application is the property of Bellson Animal Hospital.*

I have read the terms and agree.

Signature

Bellson Adoption Application

Applicant Details