AdoptionApplication

Current/Past Pets
Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered (fixed), Living/Deceased)*
Are all of your pets currently spayed/neutered*

YesNoI have no current pets
Are all of your current pets currently on heartworm and flea/tick prevention?*

YesNoI have no current pets
What medication do you use to control Heartworms?
What mediation do you use to control fleas/ticks?
If you have current pets, are you willing to bring them to our shelter for a "meet and greet"?*

YesNoI do not currently own any pets
Why?

References

Please no family members as references
Reference #1: Full Name*

First NameLast Name
Relation to applicant(s):*
Phone Number*

Area CodePhone Number
Reference #2: Full Name*

First NameLast Name
Relation to applicant(s): *
Phone Number*

Area CodePhone Number
I certify that the above information is accurate and complete to the best of my knowledge. I understand that the SJBHS has the right to reclaim the animal if any given information is found to be false. I authorize the release of veterinarian information related to my current and past pets. I understand that any animals I am fostering are teh sole property of the SJBHS. Any costs other than food and vetting are my responsibility and will not be reimburssed by the SJBHS.

By signing this electronic application, I will apply with the adoption contract if I am approved to adopt from SJBHS.
Date*

MonthDayYear
Your name*
E-mail
Should be Empty:

Foster Application