Adoption Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
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About You
How long have you lived at your current address?
*
I currently live in a
Please Select
House
Apartment
*
.
I
Please Select
Rent
Own
*
.
If renting, what is your landlord's phone number?
Please enter a valid phone number.
Format: (000) 000-0000.
Do you plan on moving soon?
*
Yes
No
Are you over the age of 18?
*
Yes
No
Are you open to a home visit?
*
Yes
No
Where are you employed?
*
What are your working hours?
*
Full Time
Part Time
Unemployed
Retired
How many adults live in your home?
*
How many children live in your home?
*
If there are children in the home, how old are they?
Will family or friends come to visit with their own pets/children?
*
Is anyone in the household allergic to pets? If yes, what kind(s) of animals?
*
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Your Home
For whom are you adopting this pet?
*
Self
Family
Gift
Have you ever adopted from a shelter before? If yes, where and when?
*
Who will be the primary caretaker of this pet?
*
Where will this pet be kept?
*
Inside Only
Outside Only
Free to Roam both Inside and Outside
If interested in adopting a dog, how will you keep this pet confined to your property?
*
Fenced In Yard
Run or Tie Out
Leash Walked
Training
N/A
How many hours per day will the pet be left alone?
*
Rarely
4 to 8 Hours
10 to 12 Hours
12+ Hours
Where will this pet be kept when alone?
*
Where will this pet sleep at night?
*
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Previous Pet History
Have you ever given up a pet for any reason? If yes, please explain.
*
Have you ever had a pet hit by a car?
*
Please list any pets you have at the present time.
*
Please specify species, ages, and breeds of all pets listed.
Can you provide proof of rabies for your current pets?
*
Yes
No
No Current Pets
Please list any pets you've had in the past 5 years.
*
Please specify species, breed, and ages of all pets listed.
Were these pets spayed/neutered?
*
Yes
No
Not All of Them
I have not had any pets in the past 5 years.
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Vet Information
Veterinarian's Name
*
Veterinarian's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Do you give us permission to contact your veterinarian as a reference?
*
Yes
No
I currently do not have a veterinarian.
Whose name are the records under?
First Name
Last Name
Do you ever use a walk-in clinic for your pet's vaccinations?
*
Yes
No
No Current or Previous Pets
If you do use walk in clinics for vaccinations, where do you typically go?
* This would include rabies clinics such as Tractor Supply Co, Woodland, etc.
If you do not have a veterinarian, please list three non-family references and their phone numbers.
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Your Adoption Preferences
What kind of breed, personality, or other traits are you looking for in your newly adopted pet?
*
For example, would you prefer a calm or active pet? What size would you prefer? Is shedding a concern? Are you looking for male or female?
Which animal(s) are you interested in adopting?
*
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