Pet Adoption Application
Your Name
*
First Name
Last Name
Which dog or cat are you interested in adopting?
*
Are you over the age of 19:
*
Yes
No
Your Address:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your E-mail Address:
*
example@example.com
Your Employer & Employers Address & Phone number:
Your Employers E-mail Address:
example@example.com
Do you:
*
Rent
Own
Live with Parents
School Housing
Other
Provide the name of the owner of the home or landlord's name and phone number for the above address:
If renting is your name on the lease?
Yes
No
If renting do you have the landlords permission to have a dog or cat? (We may require written approval from your landlord.)
Yes
No
A second or third dog or cat
Will your pet live somewhere else other than listed above on a regular basis?
Yes
No
if Yes please provide the address below
Alternate pet residence address:
If you live with parents, please list their name(s) and phone number. Do you have their permission to have a pet?
Number and age of children living at home:
Do other children and/or pets visit often?
Yes
No
If yes, provide the ages and types of pets who visit
Age and type of children and pets who visit often:
Is this pet for:
You
Children
Family
Someone else
I am looking to adopt because:
Have you adopted a shelter pet before? What type of pet? Who did you adopt the pet from?
*
Do you have other animals in your home/apartment/living area? How many and what type are they? Please identify and describe:
If you are applying to adopt a dog: Do you have a fully fenced yard?
Yes
No
What is they height and type of fence?
Where will your pet primarily live?
Inside
Outside
Will someone be home during the day?
Yes
No
How many hours will your dog be alone each day?
Where will the dog stay when he/she is home alone?
Indoor/Outdoor
Doggy-door
Run of the house
Crate
Specific Rooms
Other
Outside only:
Yard
Garage
Enclosed Patio
Other
Veterinarian Information (we may contact your Vet)
Name, address, phone, name your animal records are under
Are all of your other and previous pets:
Spayed
Neutered
Current on vaccines
Application Submission:
*
By submitting this application, I attest that the information I provided is true, accurate and complete. I understand that submission of this application does not guarantee an adoption of a pet.
Submit
Should be Empty: