Adoption Application

Animal you are interested in adopting If unsure please use description (dog, puppy, cat, kitten)
Describe the animal you are interested in Describe the animal you are interested in; small breed dog, tabby kitten, 1-legged chicken.
Personal Information
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Alternate Phone Number
Date of Birth *
Drivers License Number *
Have you ever been charged with abuse or neglect of an animal? *
If yes, please explain:
Tell us about any other pets.
Is this pet for you or someone else? *
Do you own other pets at the current time? *
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed? *
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?
Have you ever turned your dog or cat into a shelter? *
If yes, please explain?
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number *
What arrangements will you make for the care of your pets in case of an emergency? *
If you answered "other" above, please explain:
Where will the animal sleep? *
If you answered "other" above, please explain:
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
If no, please explain:
What is the main reason you plan to adopt a pet:
If you answered "other" above, please explain here:
What would you do with your animal if you had to move? *
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
Tell us about your home.
Do you own or rent your home? *
Please select your current residence type. *
If you answered "other" above, please explain here:
How long have you lived at this address? *
If you rent, does your landlord and lease allow pets?
Landlord Name and Number *
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
On average, how many hours per day will your pet be left alone?
Will this pet be predominantly living inside, outside, or both? *
Do you have a fenced-in yard? If so, what kind of fence? *
If you answered "other" above, please explain:
Please provide 2 personal references.
Personal Reference *
Reference Contact Number *
Personal Reference 2 *
Reference Contact Number 2 *
Will you allow us to perform home checks? *
How did you find out about us?