North Platte Animal Shelter Application

NAME OF ANIMAL YOU WISH TO ADOPT:*
Full Name*

First NameLast Name
Spouse/Significant Other's Full Name

First NameLast Name
E-mail*
What is your birthday?

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Your Place of Employment and Occupation*
Spouse's Place of Employment and Occupation
Skip if not applicable.
Personal Reference #1 (non family member) *

Name of ReferenceRelationshipPhone Number
Personal Reference #2 (non family member) *

Name of ReferenceRelationshipPhone Number
Household Information
HouseApartmentCondoMobile HomeOther
OwnRentLive at home
YesNoI'm not sure
If you rent, what is your landlords info? We will contact them to confirm pets are allowed.

NamePhone Number
Cozy (Under 1,000 square feet)Roomy (1,000-2,000 square feet)Spacious (2,000 square feet +)Other
Less than 1 year1-3 years3-5 years5+ years
Do you have any plans to move? If so, when?
If you move, what will you do with your animals?*
How many adults are in your home?*
How many children are in your home?*

Number of childrenAges of children
YesNo
If fenced, please list what type and height. (Example: Chain Link, 4 foot or Privacy, 6 foot, etc.)
YesNo
If allergies arose, what would you do?*
YesNo
Quiet/Very few visitorsModerate/Some visitorsActive/Frequent VisitorsVery active/Lost of noise and visitors
Pet History
Do you own other pets?*

Yes or NoTotal number of animals
Are your pets current on vaccines?
Are you dog current on heartworm test and prevention?
YesNoOther
NoYes, I had them declawedYes, they came to me that wayOther
Animal #1 - What is their name, breed, gender, age, are they spayed/neutered and how long have you owned this pet?
Animal #2 - What is their name, breed, gender, age, are they spayed/neutered and how long have you owned this pet?
Animal #3 - What is their name, breed, gender, age, are they spayed/neutered, and how long have you had this pet?
Animal #4 - What is their name, breed, gender, age, are they spayed/neutered, and how long have you had this pet?
Animal #5 - What is their name, breed, gender, age, are they spayed/neutered, and how long have you had this pet?
YesNo
Have you had other pets in the last 5 years? If yes, what happened to them?*
Have you ever had to give up a pet for adoption? If yes, please explain.*
Are the current pets in your home familiar/socialized with the type of pet your applying to adopt?
Example: Has your dog been around cats? Has your cat been around dogs? Has your cat been around other cats? Etc.
Pet Information
YesNo
What is the greatest number of hours the pet will spend alone during the given times?*

Day TimeNight Time
CrateIndoors, free roamingOutdoorsGarageBasementIn a runOther
CratePet BedShare bed with ownersDesignated RoomOutdoorsGarageBasementOther
YesNo
YesNo
Family or friendAt homeIn boardingIn home pet sitting
What types of activities do you plan for you and your pet?*
YesNo
YesNoMaybe
More Information
Have you ever adopted from a shelter rescue before? If so, what shelter or rescue and when?*
MovingNew babyDivorce/Break upNew jobIllness/allergiesProblem with pets healthProblem with pets behaviorExpensive vet billsOther
First time dog ownerHad one or two dogs in my lifeHad dogs growing upExperienced dog owner (had dogs with special needs or behavioral issues)
If you have had a special needs dog in the past, what needs did they have? (Blind, deaf, unsocialized, illness, etc.)
First time cat ownerHad one or two cats in my lifeHad cats growing upExperienced cat owner (had cats with special needs or behavioral issues)
If you have had a special needs cats in the past, what needs did they have? (Blind, deaf, unsocialized, illness, etc.)
How much do you think this pet will cost you each year? (Please consider their food, vet visits, flea/tick/heartworm control, toys, grooming, etc.)*
We want our shelter pets to have forever homes. Some pets have a tougher time transitioning than others. (Examples may be: chewing or unwanted behavior, marking, cat scratching, longer time getting along with other pets in household, etc.) What steps do you plan to take to ensure that the pet stays with your forever and not just 'until'?*
Please tell us why you are interested in adopting this particular pet. What drew you to him/her? Why do you think you should be his/her forever family? Pretend I have the winning lottery ticket in my hand - convince me why you should get it 😊*
Photo Submissions.

These are extremely helpful, especially if you aren't local.
Feel free to upload any pics of your pets, home or anything you feel might be an asset to your application

Browse Files

Cancelof
Feel free to upload any pics of your pets, home or anything you feel might be an asset to your application.

Browse Files

Cancelof
Feel free to upload any pics of your pets, home or anything you feel might be an asset to your application.

Browse Files

Cancelof
Feel free to upload any pics of your pets, home or anything you feel might be an asset to your application.

Browse Files

Cancelof
Feel free to upload any pics of your pets, home or anything you feel might be an asset to your application.

Browse Files

Cancelof
YesNoNot Sure
Is there anything not mentioned that you would like us to know or that we should know?
Veterinarian Information
Name & Info of your current veterinarian:*

Name of Veterinarian Clinic

Address of Veterinary Clinic

Name of VeterinarianCity/State

Phone NumberCountry
YesNoOther
...you're almost finished!

Please read these statements carefully and initial each if you agree.
Entering your name here is proof of signiture that you understand the application and have completed it to the best of your ability.*

First NameLast Name
Date of application

MonthDayYear
Should be Empty:

Household Information

Pet History

Pet Information

More Information

Photo Submissions.

Veterinarian Information

...you're almost finished!