Adoption Application
Thank you for interest in our loving homeless pets!
Please provide the name of the pet you are interested in:
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Please enter date you are applying
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Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?:
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Are you planning on moving within the next 6 months?
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Yes
No
If yes, what are your plans for your pets if you move?
Your E-mail
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Your Cell Phone Number
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Area Code
Phone Number
Name of Spouse/Partner/Adult living in the household
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Their Cell Phone Number
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Area Code
Phone Number
Name and age of ALL occupants in household (including yourself):
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Name of Employer:
Employer reference name:
Work Phone Number
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Area Code
Phone Number
Are you 18 years of age or older?
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Yes
No
Do you own your own home?
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Yes
No
If you rent, do you have permission to own a dog or cat?
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Yes
No
If you rent, name and phone # of landlord:
Type of Dwelling:
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Please Select
House
Apartment
Condo
Mobile Home
If no children, do you plan on having children or will children be visiting the household frequently?
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Yes
No
What is your reason for wanting to adopt a dog or cat?
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House pet
Companion
Companion for pet
Other
If adopting a dog, what is your experience level of training?
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Experienced
Intermediate
First time dog owner
Other
N/A
If other, please explain:
How many total hours will your new pet be left alone during the day?
*
If adopting a dog how many total hours will your new dog be outside alone during the day? If adopting a cat N/A
*
If adopting a puppy, where would the puppy be kept when alone? If adopting a cat N/A
Do you understand the importance of crate training a pup and/or a new dog of any age? Explain your knowledge. If adopting a cat N/A
Do you have a fenced yard?
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Yes
No
If yes, how tall is your fence?:
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Will your adopted dog or do your current dogs be put on a tie out?
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Yes
No
Not sure
N/A
Are any members of your household allergic to animals?
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Yes
No
If yes, please describe:
Who will have chief responsibility for the care of your new pet?
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Over the past 5 years, how many pets have you owned? (Include current pets)
*
Please Select
0
1
2
3
4
5
6+
If you no longer have them, what happened to them?
List each individually including breed, age, still living with you?
Have you and your spouse (if applicable) ever owned a pet together?
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Yes
No
N/A
If yes, when?
Are you committed to care for this dog or cat for their entire lives?
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Yes
No
Do you have a caretaker that can care for your pet if something happens to you?
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Yes
No
Name and number of person inheriting your pet if you no longer can provide care.
Have you ever lost, given away a pet or surrendered to a shelter?
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Yes
No
If yes, Please explain what happened.
If you currently own a dog or cat, how does he/she react to new pets?
Does your present dog or cat have any behavioral problems?
Are your present pets up-to-date on their vaccines and flea/tick preventative?
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Yes
No
N/A
If no, please explain:
Are your present pets spayed or neutered?
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Yes
No
N/A
If no, please explain.
Were your previous pets spayed or neutered?
*
Yes
No
N/A
If no, please explain.
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:
*
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior?
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Contact a Professional
Research on line
Personal Knowledge
Other
N/A
If other, please explain:
What type of solution would you be willing to try if housebreaking accidents continue after the first few weeks (check all that apply)?
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Try crate training
Use positive enforcement
Use potty pads
Have dog/cat examined by vet
Use a dog door
Return dog/cat
None
Other
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?
*
Yes
No
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?
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Yes
No
Do you understand the importance of your new pet being part of the pack by sleeping in a room with a household member in a crate or if housebroken, on their own bed to avoid separation anxiety.
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Yes
No
Please explain your knowledge:
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Will your dog or cat spend most of their time indoors and supervised when outside?
Yes
No
Please explain:
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If adopting a cat, will your cat be indoor only or indoor/outdoor? Explain:
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If adopting a cat, are you willing to be educated (if not already) on why cats should not be declawed for health/behavioral reasons? Explain:
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Do you understand there will be an adjustment period for your new pet to settle into your new home.
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Yes
No
Explain your knowledge
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Please provide 3 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.
Reference #1
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First and Last Name & Relationship to Self
Reference # 1 Phone Number
*
-
Area Code
Phone Number
Reference #2
*
First and Last Name & Relationship to Self
Reference #2 Phone Number
*
-
Area Code
Phone Number
Reference #3
*
First and Last Name & Relationship to Self
Reference #3 Phone Number
*
-
Area Code
Phone Number
If there is anything else you think we should know, please note it here.
1. I agree that the information I have provided is true. I understand that applying and/or a meet and greet does not guarantee adoption. I also understand that adoption fees are donations towards the care and medical needs to continue to help each rescue dog/cat who takes the place of a adopted one. These adoption fees and/or deposits are non-refundable.
Please allow 1 to 2 days to process your application. You will be contacted by the phone or email, provided.
Thank you for considering an Animal Care and Welfare pet!
Signature
Submit Adoption Application
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