Animal Medical Center Adoption Application Form

Animal Medical Center

Adoption Application
Name of Animal:
Dog or Cat:
Date:

MonthDayYear
Date
In order to be considered as an adopter you must:
- Be 18 years of age or older
- Have identification showing your present address
- Have the knowledge and consent of your landlord
- Be able and willing to provide a loving, safe and peaceful environment for this pet
- Be financially stable and willing to provide any necessary medical care
Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.
Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.
Name:
Age:
Phone Number

Area CodePhone Number
Email:
example@example.com
What is the best way to contact you?
Address

Address

Street Address Line 2

CityState / Province

Zip
Occupation:
Spouse's Occupation:
Please list the name, age and relationship to yourself of each person currently living in your house (ex Mary, spouse 35)
Does anyone living in your home have any known allergies to cats?

Yes No
Your type of dwelling:

HouseCondoApartmentTownhouse
Your type of dwelling:

OwnRent
Length of time at current residence?
Do you plan to move within the next 6‐12 months?

NoYes
If you rent, are pets allowed?

YesNo
What is the name of the property owner/ agent?
Contact name and phone number:
Why do you want to adopt at this time?

Gift (for whom)Companion for the familyOther
Do all adults in your household know you plan to adopt?

Not ApplicableYesNo
Do your current pets get along with other animals?

YesNoOther
Will this pet will be:

Indoor onlyMostly IndoorMostly OutdoorOutdoor only
PAST/PRESENT PET HISTORY
Please list the name, type, age, gender, and if pet is spayed or neutered of ALL current animals. (example: Duke, Yellow lab, 1 year old, male, neutered)
Please list age, type, gender and if the pet was spayed or neutered for all animals you no longer have and what happened to that animal. (Ex Rosie, German Shepard, spayed female, passed away due to old age)
Are your animals current on all vaccinations?

NoYesOther
Date of last vaccinations:

MonthDayYear
Date
If adopting a CAT, do you plan to declaw?
How often do you think a dog/cat should go to the vet for routine care?
Name of current or last veterinarian? Name/phone number?
May we contact this vet as a reference?

YesNoOther
Which of the following situations would lead you to give away your pet?

Moving to another stateFleas or sheds too muchHaving a babyFinished school/ moving back homeRuins the furnitureChildren will no longer care for dogToo expensiveAllergiesGetting a divorce or marriedFound a new “no pet” rentalGrew too bigDigging/ ChewingWould not give up for any reasonOther
What would you do with your pet if you could not keep it for any of the reasons stated above?
Have you ever surrendered a pet to a shelter/pound?

YesNo
If yes, why?
Would you allow an inspection of your home?
PLEASE PROVIDE TWO PERSONAL REFERENCES:
Name

First NameLast Name
EMAIL:
example@example.com
Phone Number

Area CodePhone Number
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
How did you hear about this adoptable pet?
Is there anything else you would like to tell us that you think would be important when considering your application?
Please read and sign below: Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable.
I have completed this application truthfully and fully understand the adoption process.
Signature:

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Date:

MonthDayYear
Date
If we do not call or email you within 7 days of receiving your application it means that either: 1. The pet was adopted by a previous applicant. 2. We felt the situation presented on the application was not the right situation for the pet.
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!
Should be Empty:

Animal Medical Center

In order to be considered as an adopter you must:

PAST/PRESENT PET HISTORY

PLEASE PROVIDE TWO PERSONAL REFERENCES:

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!