Mountainair Animal Shelter Adoption Application

Town of Mountainair

Adoption Application
Pet's Name*
Pet's Sex*

MaleFemale
Pet's Description*
Name*
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
Cell Phone #*

Area CodePhone Number
Other Phone #

Area CodePhone Number
Employer*
Position*
How Long?*
Business Phone #*

Area CodePhone Number
You live in a:*

HouseCondo/TownhomeApartmentOther
Do you rent or own this property?*

RentOwn
Do you have a yard?*

Yard, fencedYard, no fenceNo yard (apartment/condo/townhome)
Length of time at current residence?*
If you rent, we will require landlord approval prior to adoption (phone call, email, etc).
Landlord's Name
First & Last Name
Landlord's Phone #

Area CodePhone Number
Are pets allowed?

YesNo
Number of ADULTS in household **
Number of CHILDREN in household and AGES*
Child 1 Name - Age, Child 2 Name - Age, etc
Spouse/Roommate's Name
Are any members of your household allergic to cats?*
Are any members of your household allergic to dogs?*
Please list any pets CURRENTLY living in your home. (Name, Species, Breed, Sex, Age)*
Name, Species, Breed, Sex, Age
Please list all PREVIOUS pets over the last 10 years and state why they are no longer with you.*
Name, Species, Reason
My current pets are:*

Up-to-date on vaccinesSpayed/NeuteredOn heartworm preventativeN/A
Veterinarian you currently use or plan to use*
Where will this pet spend most of its time?*

CrateIndoorsOutdoorsGarage/ShopBasementOther
Where will this pet stay when you are away on vacation?*
Do you have any additional comments, questions or concerns?*
By my signature below, I authorize the Town of Mountainair or volunteers of Friends of the Mountainair Animal Shelter (FOMAS) to contact:
- My veterinarian(s) to check the care provided to previously and/or current pets, and to check the spay/neuter history;
- My landlord to ensure that I have his/her/its permission to keep pets) on the premises; and
- My employer to confirm employment.
I certify that the statements made on this application are true and accurate to the best of my knowledge. I understand that false statements by me may lead to the rejection of this application for adoption.

By typing your name below, you agree this serves as your legal signature.
Signature*
Date*

MonthDayYear
Should be Empty:

Town of Mountainair