LUCKY CHARM MICROFARM
719-440-0644 | Luckycharmmicrofarm@gmail.com | www.luckycharmmicrofarm.com
PET ADOPTION APPLICATION
PERSONAL INFORMATION
Name:
*
Date of Birth:
*
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Month
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Day
Year
Date
Address:
*
Phone Number:
*
Format: (000) 000-0000.
Email:
example@example.com
HOUSEHOLD INFORMATION
Type of Residence:(House/Apartment/Condo/Other)
*
Do you Rent or Own?
*
Landlord's Name and Contact Information:
Number of Adults in Household:
*
Number of Children in Household and Their Ages:
*
Is Everyone in the Household in Agreement with Adopting a Pet?
*
Are All Household Members Aware of and Committed to Caring for a Pet?
*
PET PREFERENCES
Type of Pet Interested In:(Dog/Cat/Other)
*
Breed Preferences (if any):
Age Range Preferred:
Gender Preference:
Activity Level Desired:
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PET CARE AND LIFESTYLE
Have You Owned a Pet Before?
*
Where Will the Pet Be Kept During the Day?
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Where Will the Pet Sleep at Night?
*
How Many Hours Will the Pet Be Alone Each Day?
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How Will You Exercise and Socialize the Pet?
*
Do You Have a Fenced Yard?
*
CURRENT PETS (IF ANY)
Number of Current Pets:
*
Type/Breed of Each Pet:
*
Are Your Pets Spayed/Neutered and Up-to-Date on Vaccinations?
*
How Do Your Pets Typically React to New Animals?
*
VETERINARY INFORMATION
Veterinarian's Name and Contact Information:
*
Name(s) of Pets Seen by This Veterinarian:
Are Your Current/Past Pets Listed Under a Different Name?
GENERAL QUESTIONS
What Will You Do if You Encounter Challenges with Your Adopted Pet?
Under What Circumstances Would You Consider Surrendering Your Pet?
*
Are You Willing to Allow a Home Visit Prior to Adoption?
*
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ADDITIONAL INFORMATION
Is There Anything Else You Would Like Us to Know About You or Your Living Situation?
I certify that all information provided on this application is true and accurate to the best of my knowledge. I understand that completion of this application does not guarantee adoption of a pet and that LuckyCharmMicrofarm preserves the right to deny any application.
Signature
*
Date
*
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Month
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Day
Year
Date
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