Animal Adoption Application
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
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Applicant Additional Information
Occupation
*
Employer
*
Do all of the members of your family know that you plan to adopt?
*
Please Select
Yes
No
Are you over the age of 18?
*
Please Select
Yes
No
If you are under the age of 18, please provide the following:
Name of your guardian
First Name
Last Name
Phone Number
Please enter a valid phone number.
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Home & Household Information
Regarding your home, which of the following describes your living arrangements?
*
Please Select
I own my home
I rent from a landlord
I live it my parents
I live with other family
Landlords Name (If you live with family, please list the head of household)
*
First Name
Last Name
Landlord's Phone Number
*
Please enter a valid phone number.
Do you have a fenced yard
*
Please Select
Yes
No
How tall is your fence in feet?
*
How many adults live in your home?
*
Do you have children in your home?
*
Please Select
Yes
No
How many children do you have, and what are their ages?
*
Is there anyone who lives in your home who has allergies to animals?
*
Please Select
Yes
No
Please describe any allergies to animals?
*
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Animal Information and Care
What is the name of the animal which interests you?
*
Who will be the animals primary caretaker?
*
First Name
Last Name
How many hours a day will this animal spend alone?
*
Please describe in full hours
Where will your animal spend their days?
*
Is the animal you are applying to adopt a cat?
*
Please Select
Yes
No
Will your cat be allowed outdoors?
*
Please Select
Yes
No
Not Sure
Will declaw your cat?
*
Please Select
Yes
No
Not Sure
If you move will you take your pet with you?
*
Please Select
Yes
No
Can you afford medical care for your pet, including yearly vaccinations?
*
Please Select
Yes
No
What will you do if your pet damages your furniture?
*
What will you do if your pet scratches or bites someone?
*
Do you have other pets in your home?
*
Please Select
Yes
No
Please provide information about the pets in your home.
*
Pleas include the pets name, species, and how long you have had the pet. List all pets.
Have you owned pets which do not live with you anymore?
*
Please Select
Yes
No
Please provide information about the pets you have had in the past.
*
Pleas include the pets name, species, and how long you have had the pet. List all pets.
Do you have a current veterinarian?
*
Please Select
Yes
No
Veterinarian Name
*
First Name
Last Name
Veterinarian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinarian Phone Number
*
Please enter a valid phone number.
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Agreement and Submission
The information I have provided in this application is true. I understand that any misrepresentation of the information I have provided may result in losing my adoption privileges. It is possible that when the animal you are adopting has been exposed to Canine and Feline diseases that they may not show symptoms immediately. There is even a chance that an animal may carry a disease that is transmittable to people. It is imperative you make an appointment with your veterinarian as soon as possible for your new pet. I hereby release the Tooele City, the Tooele City Animal Shelter and its agents of any liabilities related to the adoption of this pet. The Tooele City Animal Shelter reserves the right to deny any application without explanation. All decisions are final.
Signature Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Submit
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