Please check here if you have read and understand the above statement.
PERSONAL INFORMATION
Please fill out your email address (required so we can respond)
Name of Pet(s) you are interested in adopting (required)
Required.
First & Last Name (required)
Required.
Address (required)
A value is required.
Required.
City (required)
Required.
State (required)
Required.
Zip (required)
Required.
Home Phone (required)
Required.
Cell Phone
Work Phone
Driver's License #
PLEASE FILL IN THE BLANKS
Do you live in a (choose one).
Please choose one:
Home
Apartment/Duplex
Condo
Mobile Home
How long have you lived at the above address?
Do you own or rent?
Please choose one:
Rent
Own
Does your lease allow pets?
Please choose one:
Yes
No
Any restrictions? If so, what are they?
Have you paid your pet fee/deposit.
Please choose one:
Yes
No
N/A
Landlord's Name & Phone Number?
Your previous address?
Are you currently employed?
Please choose one:
Yes
No
If yes, where?
INCLUDING YOURSELF, please list the Age, Gender, & Relation of ALL the people living in your household (also include any others who spend a majority of their time at your house).
Do you live with your parents?
Please choose one:
Yes
No
If so, are they in agreement with this adoption?
Please choose one:
Yes
No
Do you expect any lifestyle changes in the next 2 years? (moving, marriage, new baby, caring for elderly relative)
Does any member of your household have pet allergies?
Please choose one:
Yes
No
Do you or anyone else smoke inside the house?
Please choose one:
Yes
No
Have you ever adopted a pet from the Pet Placement Center or another rescue organization?
Please choose one:
Yes
No
If yes, which organization(s)?
How long ago?
Where is/are the pet(s) now?
Pre-adoption or follow-up home visits may be required. Would you object to home visits?
Please choose one:
Yes
No
If you answered yes to the above question, please explain?
PET HISTORY - Dogs
Do you currently own any dogs?
Please choose one:
Yes
No
Please list the breed/age/gender of all your dogs:
Is/Are your dog(s) spayed or neutered? If not, please explain:
Is/Are your dog(s) up to date on vaccines?
Please choose one:
Yes
No
Are you familiar with heartworm disease in dogs?
Please choose one:
Yes
No
What brand of preventative do you currently use or plan to use?
Where do your dogs stay during the day?
Where do your dog(s) stay at night?
Besides what is listed above, how many other dogs have you had in the past 5 years? (required)
Required.
What happened to the dog(s)?
Has a dog died on your premises of Parvo, Distemper or any other unknown causes in the past 3 months?
Please choose one:
Yes
No
PET HISTORY - CATS
Do you currently own any cats?
Please choose one:
Yes
No
Please list the age/gender of all your cats
Is/Are your cat(s) de-clawed?
Please choose one:
Yes
No
Is/Are your cat(s) spayed or neutered? If not, please explain:
Is/Are your cat(s) up to date on vaccines?
Please choose one:
Yes
No
Where do your cats stay during the day?
Where do your cats stay at night?
Besides what is listed above, how many other cats have you had in the past 5 years? (required)
Required.
What happened to the cats?
Has a cat died on your premises of Feline Distemper, Leukemia, FIV or any other unknown causes in the past 3 months?
Please choose one:
Yes
No
Do you own any other type of pet(s)?
Please choose one:
Yes
No
If yes, what kind(s)?
Please list the name/phone # of the veterinarian you currently use or plan to use? (required)
If you are adopting a dog, how do you plan to house train it?
Do you need any suggestions for training?
Please choose one:
Yes
No
If scratching became a problem, would you consider de-clawing your cat?
Please choose one:
Yes
No
How do you plan to handle scratching or other destructive behaviors?
Where will this pet live (click all that apply)? (required)
Choose all that apply:
Indoor only
Outdoors only
Indoors most of the time
Outdoors most of the time
Come and go when it pleases
Is your yard fenced (click all that apply).
Please choose all that apply:
Front completely
Back completely
Front and back completely
Front and back partially fenced
Only have fenced pen/kennel
Not fenced at all
What type of fence do you have?
How high is your fence?
Do you have a pet door? (required)
Please make a selection.
Is there a dog house?
Please choose one:
Yes
No
Do you plan to have this pet spayed or neutered?
Please choose one:
Yes
No
If you answered no to the above question, please explain?
Will an adult be home during the day?
Please choose one:
Yes
No
Who will be responsible for the new pet?
Why do you want to adopt a new pet (check all that apply).
Please check all that apply
Family Pet
Watch Dog
Companion
Hunting Dog
Barn cat
Gift for someone else
Child's pet
Breeding
Companion for other pet
Mouser
What would you do with this pet if you have to move from your current home?
What do you plan to do with this pet when you go on vacation?
What would you do with this pet if your current relationship with your roommate, spouse, or significant other should change?
Who would become responsible for your pet should you become unable to care for it due to illness or death?
(required)
Name
Rrequired. Address
Required. City/State/Zip
Required. Phone
Required.
I, the undersigned, do certify that the above information is true and accurate. If the adoption I am applying for is approved, I promise to care for the animal to the best of my ability and abide by all state and city laws concerning animals. I understand that abuse, neglect or failure to comply with any of the provisions of the adoption or to fail to hold true to information given in the application will result in removal of the adopted animal from my custody.
Signature
A signature is required.
Date
A date is required.
If you are a renter, please understand that we will contact landlords, property owners or apartment managers before approving any adoptions. We will also check with parents with whom you live before approving any adoptions. This cuts down on the number of adopted animals having to be returned when landlords or parents say no!
Please check your email account as we will be contacting you if we have further questions. Please give us at least 48 hours to respond to your application. Thank you for looking to adopt a shelter pet!
