Name
Address
City, State & Zip
Phone Number
E-mail address
Number of persons in your household
One
Two
Three or more.
Children?
Yes
No
If Yes, what are their ages?
YOUR HOME
Do you rent or own?
Own
Rent
Does your lease or homeowner's association restrict pet ownership?
Yes
No
Don't Know
Is your yard fenced?
Yes
No
REFERENCES
Please provide the names and telephone numbers of three references INCLUDING: Your veterinarian and, if applicable, your landlord. Other references could include a friend, neighbor, employer, relative, etc.
Name, Phone #, Relationship to Applicant
CARE & RESPONSIBILITY
Are you prepared to make a commitment to care for this dog/cat for the next 10-15 (in the case of a dog) or 18-20 years (in the case of a cat)?
Yes
No
Don't Know
Are you prepared to commit to find a home where you can keep this dog/cat if/when you move during the next 10-20 years?
Please read .
Yes
No
Don't Know
Are you financially prepared to deal with the cost of both routine (vaccinations, annual examinations, dental cleanings, heartworm treatment, etc.) and non-routine/emergency veterinary care of this dog/cat?
Please read .
Yes
No
Don't Know
Approximately how many hours a day will your new dog/cat be alone?
Where will the dog/cat spend the day?
Where will your new dog/cat sleep?
Who will have primary responsibility for the care of the dog/cat?
HISTORY OF PET OWNERSHIP
What animals currently live in your household?
(Please list type of animal, sex, age and how long you have owned them)
Are these pets housed inside or outside? (please explain)
Which pet would you like to adopt and why?
All of the information that I have provided above is true and complete to the best of my knowledge. Should a dog or cat be placed with me, it will reside in my home as a pet. I agree to provide the dog or cat with adequate food, water, shelter, affection, and medical care.
Signature of Applicant:
Date of Application:
How would you like us to contact you?
Via E-Mail
Call during the day
Call during the evening
Thank you for taking the time to complete this questionaire fully.
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