Adoption Form

Primary Adopter

First name and Middle Last Name

Age

Place of Employment: (business name, street name and city)

How long employed at this business?

Boss/supervisor name and phone number if available

What is your primary reason for wanted to adopt

Are you applying to adopt a cat, dog, or both?

catdogbothOther

Give name of dog or cat are you interested in...

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

How long have you lived at the address listed?

If at current address less than 3 years please put last address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Facebook Name

E-mail

Phone Number

Area CodePhone Number

Current Property Type:

Rental Property

YesNo

If yes, Does your landlord allow pets?

Any breed and/or size restrictions from landlord?

yesnoi have not checked.

What type of yard do you have?

FencedUnfencedNo yard

If fenced please indicate height

Who do you live with?

How old are they, and what is their relationship to you?

Does everyone in your house want to adopt an animal?

Is anyone in your home allergic to animals?

How busy is your home?

ACTIVE (large family, lots of people coming and going with different schedules)MODERATE (family coming and going, typical work schedule)QUIET (small family, home most of the day, minimal coming and going)

Please list all current pets (dogs, cats,others)

If dog, Breed/Types

Ages

All animals spayed/neutered?

yesnoto be scheduled

Share personality information about your current pets

Have you ever had a pet in this current home with parvo (dog) or feline leukemia (cat)? Answering yes does not prevent you from adopting, but does require that certain things be done to your house and property if not already done as these are highly contagious to pets:

yesnounsure

What energy level of an animal are you willing to adopt?

HIGH (needs lots of exercise/attention, daily running or attention or hiking)MEDIUM (frequent walks, playtime, etc.)LOW (senior/couch potato, short walks/play time)

If you have indicated an interest in a specific animal then please state and reason why this animal interests you

How much training are you willing to do with this animal?

LOTS OF TRAINING (modify problem behaviors, train my dog to do a specific ‘job’, etc.)SOME TRAINING (housebreaking, teach to walk on leash, etc.)A LITTLE TRAINING (refresh housebreaking, basic commands, etc.

Please share anything you feel is important for us to know in order to help you find the best animal for your family:

Please provide us with TWO non-family references who have knowledge of your animal experience Must include: full name, how you know them, and their cell phone number or best number. This section must be completed.. Everyone knows at least 2 people that can tell us at least about their character even if you have never owned an animal.

Veternarian Name

Signature