GJAS Adoption Application

Gardenia E. Janssen Animal Shelter

Adoption Application
Applicant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Name of the pet you are interested in:
Household Information
Ages of the everyone in the home:
Type of Home:

Other
Is there a fenced yard?
Describe the type and height of the fence:
Do you rent or own your home?
Landlord Name

First NameLast Name
Landlord Phone
Please enter a valid phone number.Format: (000) 000-0000.
Current & Previous Pets

If you already have pets, please list: Species/Breed - Age - Spayed/Neutered - Temperament
Current Pets
Current Veterinarian

First NameLast Name
Current Veterinarian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Please tell us about other pets that you have owned. Feel free to include and information about any behavior training, disabilities and senior ages.
Lifestyle & Commitment
How many hours a day will your new pet be left alone?
Where will your pet stay when you are not at home?
Where will your pet sleep at night?
How will you handle training or behavior challenges?
Are you prepared for the financial responsibilities of pet care (food, vet, training, preventatives, emergencies)?
What do you anticipate the annual budget to provide pet care for this animal will be?
Have you ever had to return or surrender a pet?
Please provide information about the situation?
References
Please provide previous or current veterinarian information for an animal you previously or currently owned or own:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Agreement
I understand that completing this application down not guarantee adoption. Gardenia E. Janssen Animal Shelter's priority is the safety and well-being of the animal. I certify that the above information is true and complete to the best of my knowledge.
Signature
Date

MonthDayYear
Date
Should be Empty:

Gardenia E. Janssen Animal Shelter

Applicant Information

Household Information

Current & Previous Pets

Lifestyle & Commitment

References

Agreement