First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Which particular pet are you interested in?*

How did you hear about us?*

Why are you interested in adopting a pet at this time?*

What type of pet are you looking for? Housedog/Companion/Guard Dog/Working or Hunting Dog/Gift/Other*

What attracted you to this pet?

What traits are you looking for in a pet?

How many people reside in your household (adults, children)?*

What are the occupation(s) of the adults in the home?

Is anyone in the home allergic to animals?*
Choose one: Yes No Not Applicable

Who in the household will be responsible for the pet?*

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, can we contact your landlord or receive a copy of a lease agreement confirming you are allowed to have an animal?*
Choose one: Yes No Not Applicable

Where will the pet be kept when you are home?*

Where will the pet sleep?*

Where will the pet be kept when you are not home?*

How much time will the pet spend alone during the day?*

How will you keep your pet safe outdoors?*

Does your yard have a fully enclosed fenced area?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence?*

If you do not have a fence, will you be willing and able to construct a fence if your pet requires it?
Choose one: Yes No

A dog or cat may live 15 years or more. Do you agree that pet guardianship is a lifetime commitment?*
Choose one: Yes No Not Applicable

Have you ever given up a pet? If yes, please explain.*

Under what circumstances would you be unable to keep this pet?*

Veterinary costs and medications can be several hundred dollars per visit. Are you financially able to take care of this pet?*
Choose one: Yes No Not Applicable

Please List Your Current Animals:*

Are your current pets already spayed or neutered?*
Choose one: Yes No Not Applicable

Are your current pets up-to-date on their vaccinations?*
Choose one: Yes No Not Applicable

For cats only: Are you planning to declaw?*
Choose one: Yes No Not Applicable

Please describe how you will train the pet.*

If the pet became destructive or misbehaves, how will you handle the situation?*

What will happen to the pet if you unexpectedly move?*

Where would the pet be kept when you travel?*

Veterinarian's Name and Phone Number*

Please list two personal references with address and phone number.*

Would you object to an inspection of your premises by our staff?*
Choose one: Yes No Not Applicable

I certify that the information entered on this applicant is true. Enter your name and date.*