I am interested in adopting: *
Name: *
DOB: *
Occupation: *
Driver's license number: *
Email: *
Home phone: *
Work phone:
Cell phone:
Address: *
City, State, Zip: *
Emergency contact:
Did you come to our site intending to adopt a pet today?
Yes
No
Why do you want to adopt this pet?
Family pet
Child's pet
Guard dog
Hunting dog
Companion
Companion for another pet
Other
Have you ever adopted from an animal shelter/humane society/rescue group?
Yes
No
If yes, when?
What happened to this pet?
Are you willing to let us perform a home check?
Yes
No
My home is:
Apartment
House
Condo/townhome
Trailor/mobile home
Urban loft
How long have you lived at your current address? *
Do you rent? *
If so, is your landlord willing to let you have a pet?
Is there a pet deposit? How much?
Has the deposit been paid?
Yes
No
Name and contact for landlord:
How many times have you moved in the past 6 years? *
If you move, will your pets go with you?
Yes
No
Would you consider moving somewhere pets are not allowed?
Yes
No
How many people live in your household? *
Adults: *
Children and ages: *
Is anyone in your household allergic to animals?
Yes
No
Does anyone in your household have serious health problems? If so, please briefly explain:
Can you provide a home for this pet for the next 10-15 years?
Yes
No
Do you foresee any major life changes in the next 10-15 years? If so, please briefly explain: *
Do you currently have any pets?
Yes
No
If yes, please list type, name, age, breed and sex:
How many pets have you owned in the past 5 years? *
Where are these pets now?
Still with me
Put to sleep
Died of natural causes
Rehomed
Sold
Ran away
Stolen
Other
Has any dog died on your premise with distemper, parvovirus or other causes within the past 3 months?
Yes
No
Have your pets, past or present, ever lived primarily outdoors?
Yes
No
If yes, please explain:
Where will your pet stay while home alone?
Basement with pet door
Garage
Outside
Free run of the house
One room in the house
Crate
Other
On an average day, how long will your pet be left alone? *
Will your pet typically have access to the entire house?
Yes
No
If no, where will the pet be allowed?
Where will your pet sleep at night?
Garage
Basement
Outside
Free run of house
One room in the house
My room
On the bed
Other
Will your new pet be allowed on furniture?
Yes
No
Some
Are your current pets spayed/neutered?
Yes
No
If no, please explain:
Are their vaccinations UTD?
Yes
No
Do you know how to protect your dog from heartworms and fleas/ticks?
Yes
No
If you currently have a dog, is it on heartworm preventative?
Yes
No
Do you currently have a veterinarian?
Yes
No
If yes, name and phone:
If yes, can we contact them?
Yes
No
Do you plan to have your pet fully vetted once a year?
Yes
No
What do you expect annual pet care to cost (food, vet, supplies, etc...)? *
Who will be responsible for the daily care of this dog? *
Do you have a pet door?
Yes
No
Would you consider installing one if necessary?
Yes
No
Is there a yard available?
Yes
No
If yes, is it safely fenced without gaps?
Yes
No
If no, would you consider installing a fence?
Yes
No
If no, how do you plan on containing the dog while outdoors?
Chain
Runner
Tie out
Leash walk
Run/kennel
Free run
Electronic fence
Other
Do you currently have a dog house or shelter?
Yes
No
Under what conditions do you think it is okay to leave a dog unattended in an unfenced area?
Never
In a quiet subdivision
On a lot of acreage
In a rural area
When I know they're trained to come back
Other
Do you current pets, if any, wear ID tags?:
Yes
No
N/A
What do you plan to do with your pets when you are out of town? *
If you date or marry someone who does not like pets, what would you do? *
What prodecures will you use for house training?
None
Crate/confinement
Pee pads
Rubbing nose in it
Punishment
Frequent trips outside
Positive reinforcement
Training classes
Other
What plans do you have for obedience training? *
Have you ever experienced a serious behavioral problem with a pet?:
Yes
No
If yes, please explain.:
If you pet develops a serious medical expensive that becomes too expensive, what would you do? *
If your pet develops a frequent urination problem when it is older, what would you do? *
Under what conditions would you consider giving up your pet?
Moving
New baby
Problems with children
Problems with other pets
Divorce
Behavioral issues
Schedule
inancial
Size became too large
Shedding
Allergies
Medical problem
Never
Other
Have you ever been forced to take an animal t to animal control?
Yes
No
If yes, please explain:
By signing here, I am indicating that this application was filled out truthfully to the best of my knowledge: *
Date: *
