Form

PET Adoption Application
Name *
Address *
Home Phone *
Cell Phone
Email *
Employer *
Employer Address *
Employer Phone *
Pets owned now	Cat(s) Dog(s) Other
If you checked "other," list pets
How long have you owned these pets?
Why are you looking to adopt? *
Are there other decision-making adults in the household? *
Are all decision-making adults looking forward to this addition? *
Are there any children in the household? *
If you checked "yes", list ages of children	infant 1-3 yrs. 3-6 yrs. 6-10 yrs. 10-13 yrs. 13-15 yrs. 15-19 yrs.
If household member becomes allergic, explain what you will do *
Check all pet behaviors that you find intolerable *	elimination scratching biting hissing fear shyness vocalization none
Have you or would you ever declaw a cat, or debark a dog? *	yes no
If you checked "yes," please explain why
When you are out of town, who cares for your pets? *
May we contact your caregiver? *	yes no not applicable
Caregiver's name *
Caregiver's number: *
Veterinarian *
Vet's number *
Reference (family) name *
Reference number *
Reference (friend) name *
Reference number *
Have you ever adopted from a shelter or rescue? *	yes no
Have you ever returned a pet that you adopted or purchased? *	yes no not applicable
If you checked "yes, " explain the circumstances
Do you agree to pre- and post adoption home visits? *	yes no don't know
Do you agree to have unaltered pet spayed/neutered *	yes no I'll try
Do you agree to have all necessary vax, flea/worm treatments, annual vet visit, and all medical care necessary for optimal health and comfort? *	yes no I'll try
Which pet(s) are you interested in? Questions/comments?