Please answer ALL applicable questions!!

Name of dog or cat you are interested in:

Your name:

Title

Street address:

City;

County the City is in:

State;

Zip:

Home phone:

Work phone:

E-Mail Address:

BIRTHDATE:

Why do you want to adopt a pet today?

Love animals    Companion for children   

Companion for another pet  Pet Died                 

Other reason:

How long have you been looking for a pet?

How many dogs have you had in the last ten years:

How many cats have you had in the last ten years:

How many and what kinds of other pets have you had in the last ten years:

Are the pets still with you:

Yes No

If yes, how many dogs:

What kind of dogs are they and what are their names (for Vet check purposes):

If yes, how many cats:

How many other are still with you:

If any of the pets are not still with you, please explain why:

Are your pets current on their vaccinations?

Yes
No
N/A

Are your pets spayed and/or neutered?

Yes
No
N/A

Who is your current Veterinarian or who is the Veterinarian that has treated past pets? (who spayed/neutered, tested, vaccinated, etc.)

(MUST BE ANSWERED)

What is the Veterinarian's telephone number:

(MUST BE ANSWERED)

Are, or were, your cats:

Inside
Outside
Both Inside & Outside

Are, or were, your dogs:

Inside
Outside
Both Inside & Outside

Explain:

Is this pet going to be a gift:

Yes No

If yes, please explain:

Are you at least 18 years old:

Yes No

Where do you live?

In a house with a big yard
In a house with a small yard
Condo
Apartment
Farm

Do you rent your current place of residence?

Yes No

How long have you lived at your current residence?

Will you be moving soon?

Yes No

If yes, could you give us your new address and phone number?

Do you have children?

Yes No

What are their ages?

Have your children been around pets before?

Yes No

Does anyone living in your household have an allergy to animals?

Yes No

If yes, is the allergy to:

Dogs
Cats
Both

Will you take your new pet to the vet within 14 days of adoption and regularly thereafter?

Yes No

Are you willing to accept full financial responsibility for your pet?

Yes No

Where will your pet stay when you are not at home?

Crate
Loose in house
Outside
Basement
Garage

Other than options above:

Who will provide care for your pet in your absence (i.e. vacations)?

What animal behavior are you unwilling to work with:

Would you object to a volunteer visiting your home or calling you some time in the near future?

Yes No

Best time to call (include AM and/or PM):

DOG QUESTIONS

Are you willing and able to leash walk?

Yes No

Is your yard completely fenced?

Yes No

If completely fenced, what type of fence?

If recommended, are you willing to take your dog to an obedience trainer?

Yes No

What would you do if your new dog was chewing on inappropriate items?

What would you do if your new dog was having accidents in your home?

What would you do if your new dog was barking excessively?

What would you do if your new dog was running away/escaping?

What would you do if your new dog was jumping on people/furniture?

What would you do if your new dog was digging holes in your yard?

CAT QUESTIONS

Do you plan to have your new kitten/cat declawed?

Yes No

What would you do if your cat clawed or scratched your furniture?

What would you do if your cat had accident outside its litterbox?

What would you do if your cat jumped on kitchen tables, counters, or furniture?

What would you do if your cat wanted to go outside?

I CERTIFY THAT THE ABOVE ANSWERS ARE TRUE AND REALIZE THAT ANY FALSE 

INFORMATION MAY RESULT IN NULLIFICATION OF THIS ADOPTION. 

The typing in of your name is considered your signature.

   FORM TAKES A FEW MINUTES TO SUBMIT.  BE PATIENT.