Adoption Application

Dog or cat? *

Dog

Cat

Today's Date *

MM

DD

YYYY

Name *

First Name

Last Name

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does anyone in your home have any known allergies? *

Yes

No

Do you own your home or rent? *

Own

Rent

Do you plan to move within the next 6-12 months? *

Yes

No

If you rent are pets allowed? *

Yes

No

N/A

Pet Deposit? *

Yes

No

N/A

Phone number of property owner / agent: *

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Do all adults in your household know you plan to adopt? *

Yes

No

N/A

Have your children ever been around dogs and/or cats? *

Yes

No

N/A

Has your child ever been bitten by a dog? *

Yes

No

N/A

Do your current pets get along with other animals? *

Yes

No

N/A

This pet will be... *

Indoor Only

Mostly Indoor

Mostly Outdoor

Outdoor Only

How many hours per day will the pet be alone? *

0-2

2-4

4-6

6-8

8-10

10-12

Over 12

Do you have a fenced yard? *

Yes

No

Do you have a...

Balcony

Pool

Pet Door

Unscreened Windows

None of the above

Do you ever have your dog on tie out? *

Yes

No

N/A

Do you travel? *

Yes

No

Are your companion animals spayed or neutered? *

Yes

No

N/A

Are all your animals current on all vaccinations? *

Yes

No

N/A

Date of last vaccination: *

MM

DD

YYYY

Phone number of current or last veterinarian: *

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Which of the following situations would lead you to give away your pet? *

Moving to another state

Having a baby

Ruins the furniture

Too expensive

Getting a divorce or married

Grew too big

Fleas or sheds too much

Finished school / moving back home

Children will no longer care for dog

Allergies

Found a new "no pet" rental

Digging / chewing

Would not give up for any reason

Other

Have you ever surrendered a pet to a shelter or pound? *

Yes

No

N/A

Do you have a relative who would adopt the pet if you, for any reason, become incapable of caring for them? *

Yes

No

Would you allow an inspection of your home and/or yard? *

Yes

No

Name of Personal Reference *

First Name

Last Name

Phone Number of Personal Reference *

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