Pet Adoption Application Form

Potential Pet Parent*

First NameLast Name

Preferred Pronoun(s)

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How did you hear about us?

Personal Information

Please tell us what you are looking for in your new pet. Include factors such as gender, age, breed, personality, size/weight range, and hair/fur type. Also include any qualities you do NOT want.*

What are your favorite and least favorite things about having a dog or cat?*

If there is a specific dog or cat that you are interested in, please tell us their name and why.*

Who will be responsible for the dog or cat? Are you adopting for yourself?*

How old are you?*

Is your home phone number listed in your name? If not, whose name is it listed in, and what is their relation to you?*

List all persons living in your household, including their name, age, relationship to you, whether they're allergic to pets, and if they are in agreement with adopting the pet.*

	Name	Age	Relation	Pet Allergies	In Agreement?
Person 1
Person 2
Person 3
Person 4

Are you adopting a dog or cat for your home, business, or for someone else?*

Please describe your home (house, apartment, 2 bedroom, studio, farm, etc.)*

How long have you lived at your current address?*

Do you:*

If you rent, please provide your landlord's/housing management's information here (name, email, phone, address):*

What is your landlord's or building's pet policy? Are there any special regulations on having an animal with paws and claws?*

Do you have a yard?*

YesNo

If "Yes" to the above, is it fenced? Please describe (height, etc)

How will your dog get exercise/go outside?*

Who will take care of your pet if you are away?*

What is your place of employment and how long have you worked there? List your employer's address and phone number.*

If you are unemployed at the moment, how do you plan to financially afford a pet?*

How active are you and do you plan to be with your new pet?*

Do you currently own any pets (or have pets living with you)?*

YesNo

Please enter your current pet information:

	Name	Age	Species	Sex	Fixed	Last Vet Visit	Dog Friendly?	Cat Friendly?
Pet
Pet
Pet
Pet

Have you owned a pet before? If no longer with you, please explain. If they passed away, please list how and date of death.*

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?*

YesNo

If "Yes" to the above, please explain why and when.

Are you currently able to financially care for a new pet?*

YesNo

Will you take the pet to the veterinarian for annual exams and if it is ill?*

YesNo

Please provide the name of your Veterinarian:*

First NameLast Name

Phone Number of Veterinarian:*

Area CodePhone Number

Address of Veterinarian:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What kind of food will you feed your new pet? (if unsure please ask your vet, or we can provide you with some recommendations)*

On average, how many hours per day would the pet be home alone?*

Where will your pet be during the day, at night, and when you are/aren't home?*

Will you crate your pet?*

How often will you walk your dog?*

Other than the people you listed living in your home, who else will be spending time with your new pet?*

What type of training do you plan to give your dog/cat? If needed, are you willing to hire a professional trainer?*

If we could help with training, would you be interested in our assistance and recommendations?*

YesNo

Do you consent to a home visit? One will be performed before the adoption and a second will be conducted about a month after.*

YesNo

If you became ill, disabled, or otherwise unable to take care of your pet, who will take responsibility and care for it? Please provide a name, relation, address, and phone number.*

Please provide the names, emails, and contact numbers for 3 personal references:*

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo

If you answered "Yes" please provide a detailed description:

I certify that the information provided in this applicatlon is true and accurate to the best of my knowledge. By completlng this applicallon I am aware that I am not guaranteed the dog or cat I am applying for. Adoption is contingent on the Shelter Free Rescue NY's approval.

In consideration of receiving any Shelter Free NY foster animal, I, as a foster caregiver, herby release Shelter Free NY, its officers, agents and employees from all claims of injury or damage that a fostered dog/cat/other may cause me or my property. I agree to hold harmless, defend and indemnify Shelter Free NY, it's officers, agents and employees from any and all claims of liability to other people for injuries.

Print Name*

Signature*

Date*

Date

Pet Experience