Adoption Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
I certify that I am at least 21 years of age:
yes
Date of Birth
-
Month
-
Day
Year
Date
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Do you have a specific animal you would like to meet?
yes
no
If yes, please name:
How much exercise can you give your pet each day?
What will a typical day look like for your pet?
Are you willing to adopt an animal with special needs?
yes
no
depends on the situation
Are you willing to adopt an animal with special behavioral traits?
yes
no
depends on the situation
How will you handle any destructive behaviors your pet may exhibit, such as barking, chewing, digging, marking, biting, etc.?
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Have you previously owned a pet?
yes
no, this is my first pet
If yes, where are those pet(s) now?
Please list all pets you currently have:
Are each of your pets spayed/neutered?
yes
no
If not, please explain:
Is each of your pets up to date on his/her vaccinations?
yes
no
Is each of your pets currently on heart worm preventative?
yes
no
Where do you purchase heart worm preventative?
What brand?
Have you ever given up a pet?
yes
no
If yes, please explain:
Name of your veterinary clinic:
Veterinary clinic phone number
-
Area Code
Phone Number
**Please let your vet know Cubby's Crusade will be in contact.**
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Do you rent or own your home?
rent
own
If you rent, you MUST provide your landlord's name and phone number.
Landlord name:
Landlord phone:
-
Area Code
Phone Number
If you rent, are pets allowed?
yes
no
If there are restrictions on pets, please explain:
How long have you lived at your current address?
Do you have a yard?
yes
no
If yes, is your yard fenced?
yes
no
If your yard is fenced, what type and height of fence do you have?
How many hours per day will your pet be left alone?
Where will your pet be kept during this time?
Will your pet be kept primarily indoors or outdoors?
**If you expect an outdoor pet (unless this is a farm animal), please do not continue. Cubby's Crusade only places animals to be indoor family members. There are no exceptions.**
On an average day, how much time will your pet spend outdoors?
Which parts of the house will your pet be allowed to access?
Which parts of the house will your pet NOT be allowed to access?
Will you allow your pet on furniture?
Where will your pet sleep at night?
What will you do with your pet should you go on vacation?
What will you do with your pet should you move?
How many adults reside in your home?
Is everyone in your home in agreement about adopting a pet?
yes
no
If no, please explain:
Do you have children in your home?
yes
no
If yes, please list ages:
Does anyone in your home have special needs, health conditions, or allergies that we should consider when seeking your perfect match?
yes
no
If yes, please explain:
Why do you want a pet?
Under what circumstances would you give up your pet?
If you are no longer able to care for your pet, who will?
Do all persons involved know of and agree to this plan?
yes
no
If you have a baby, will you keep your pet?
yes
no
Please tell us a little about your family/lifestyle:
**CUBBY'S CRUSADE REQUIRES A HOME VISIT BEFORE PLACING ANY PETS. THERE ARE NO EXCEPTIONS.**
Applicant Signature
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: