Adoption Application Form

Adoption Application Form
Are you interested in a cat or dog?*

CatDog
Are you interested in a specific animal?
Applicant Details
Legal name*

First NameLast Name
What are your preferred pronouns and name?
Co-Adopters name if applicable

First NameLast Name
E-mail*
example@example.com
Phone Number (Mobile)*
Format: (000) 000-0000.
Age*
Address*

Street Address

Mailing Address

CityState / Province

Postal / Zip Code
Do you own or rent your home?*

OwnRent
How long have you lived at your current address?*
Landlord's Name

First NameLast Name
Landlords Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Describe the people that your animal will need to be able to live with (Select ALL that apply):*

Children under 8children 8+teenagersadultsfrequent guestsPeople with physical or intellectual disabilitiesOther
How many Adults live in your home? *
How many children live in your house?*
Ages of all children
General Home Life
I / We live in a*

Single Family HomeDuplex / TwinCondo / TownhomeTrailerApartmentOther
Which best describes where you live?*

CityTownoutside of towncountry
Describe the traffic by your home*

Heavymoderateoccasionalvery little
What word best describe your household?*

quietmoderateactivechaotic
Describe your home and the environment where the animal will primarily live and spend time*
Do you have a fenced in yard?*

YesNo
Is your home Smoke free?

YesNo
Describe your Employment Status*

Full timepart timeretiredstudent
Place of employment
City/Zipcode
What reason(s) do you want a pet?*
Who are you adopting this animal for?*
Who will be responsible for the care of this animal?*
Emergency Contact

First NameLast Name
Emergency contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Who will care for this animal when you go out of town?*
Who will care for the animal in case that you have a personal emergency?*
What will you do if your lifestyle ever changes in the future (e.g, moving, job changes, family)?*
Have you ever adopted an animal from this shelter before?:*

YesNo
If so, when, and where is this pet now?:
Have you ever surrendered an animal from this shelter before?*

YesNo
If so, why?:
How do you plan to handle any potential challenges*
Define any traits or characteristics that would be a challenge for you to handle*
Are you willing to make the financial commitment to the expense of annual or emergency vet care :*

YesNo
Do you have an established relationship with a veterinarian*

YesNo
List current or past veterinarians you have used:
Who is Veterinarian?
Clinic Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please call your vet to release your records!

Apart of our application approval is doing vet checks we cannot do this unless you call.
How often and for what do you take your pet(s) to the veterinarian?*
Please list ALL pets in your home currently and/or have had in the past 5 years:
Animal(s) in your home: please list in this order- Dog/Cat, Name, and Age.
Spayed and/or Neutered?:

YesNo
When did you get your pet(s)?:Where did you get your pet(s)?:
Please clarify the current status of the pets you listed (e.g., living, euthanized, or passed away at home).Is/was this pet up to date on vaccinations?
How do you think your current animal(s) will adjust to a new cat or dog in the home?:
(FOR DOG OWNERS...) Are your dogs licensed?

YesNoN/A
If so, in which town?:
Personal References

Please list two personal references that are NOT family members, co-adopters, spouses, etc. and include their telephone number.
Personal Reference #1:*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to the Adopter (Friend, Co-worker, etc.)*
Personal Reference #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to the Adopter (Friend, Co-worker, etc.)*
Dog Applicants

Cat applicants can skip and fill out the cat section below
Describe your ideal dog! What traits or characteristics are most important to you?
Where will your dog stay when you are not home?
When your dog is outside, how will you control him/her?
Where will your dog sleep?
Are you interested in crate training?

YesNo
Would you like training information? If obedience lessons are recommended, are you willing to pay and attend these classes?
Cat Applicants
Do you have a preference of age, sex, size, etc
Describe your ideal cat! What traits or characteristics are most important to you?
Do you plan to let your cat outside?

YesNo
What kind of cat are you looking for - indoor, outdoor, or both?

IndoorOutdoorboth
Do you plan to have a litter box?

YesNo
Do you plan to declaw this cat and if so, why?:
Anything Else?
Is there anything else you would like us to know about yourself or your plans for a new pet?
Disclaimer! Thank you for your interest in adopting and taking the time to complete this questionnaire! Your responses will help us match you with the right animal. Please remember that submitting a questionnaire does not claim an animal or place an animal on hold for you. Once your questionnaire has been reviewed, you will receive a confirmation email or phone call with the next steps in the adoption process. PLEASE READ BEFORE SIGNING -The Pope Memorial Frontier Animal Shelter (PMFAS) reserves the right to verify all information given on this application. Any misinformation or falsification will result in automatic refusal of an animal or confiscation of the animal if the adoption has already taken place. If, following verification, PMFAS criteria is not met, PMFAS reserves the right to refuse adoption. Animals adopted from PMFAS are to be placed in permanent homes where a lifetime of commitment can be assured.I, (print name):grant permission for PMFAS to verify the information I have presented on this application. I also give the veterinarian/clinic named on this application permission to release information PMFAS may request in order to process this application.
**I have read and agree to the Terms and Conditions**

YES
I confirm that all information supplied above is correct and accurate.
Print your name.

First NameLast Name
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