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Name *

Date *

Address *

City *

State *

Zip *

Home Phone

Cell Phone

Work Phone

Email *

What kind of pet are you here to adopt? Select all that apply. *
Dog
Puppy
Cat
Kitten
Other

Name of pet you are applying for

Why do you want a pet? *

Do you have any preferences as to breed, color, sex, age, size, length of hair, etc? *
Yes
No

If yes, list features important to you

Would this be your first experience owning a pet? *
Yes
No

Please list all pets you currently have in your household (ie. dog, cat, etc); what are their names; what are their ages; are they spayed or neutered? *

Are the above mentioned pets kept inside or outside? *

How many other pets have you owned in the past 5 years? *

What became of them?

Who is your veterinarian? *

Veterinarian Phone

Do we have your permission to ask your vet to give you a reference? *

Which do you currently live in? *

Do you? *

If you rent, does your lease allow pets?
Yes
No

If you rent, what is your landlord's name?

Landlord's phone

How long have you lived at the above address? *

How many people live in your house hold? *

Do all of the adults know and approve of your adopting a pet?
Yes
No

If there are children, what are their ages?

Do you or does anyone living in your household have any known allergies to animals?
Yes
No

If yes, to what kind of animal and how severe is the allergy?

Who will be responsible for the care of the pet? *

This section is for cat or kitten adoption

Select the reason(s) why you want to adopt a cat or a kitten
Family Pet
Adult Companion
Child's pet
Companion for another pet
Mouser
Barn Cat
Gift
Other

If other, please explain

Where will the cat be kept?

On average, how many hours will that cat spend alone each day without human companionship?

Do you plan to declaw the cat you adopt?
Yes
No

If yes, why?

Would you declaw the cat if it became destructive or aggressive?
Yes
No

What problems could constitute a reason for giving up your cat?

This section is for Dog or puppy adoption

Select a reason why you want to adopt a dog or puppy
Family Pet
Adult Companion
Child's pet
Companion for another pet
Mouser
Barn Cat
Gift
Other

If other, please explain

Are you willing to house-train a puppy or dog?
Yes
No

Are you familiar with crate training?
Yes
No

Have you crate trained other dogs you've owned?
Yes
No

Where will the dog be kept?

Do you have a fenced yard?
Yes
No

If no, give approximate distance to the nearest road

How would you keep your dog confined to your property when outside? (Select all that apply)
Fenced Yard
Kennel
Garage
On Leash
Chained
Other

If other, please explain

Are you familiar with the leash and licensing laws in your community?
Yes
No

Where will the dog stay while owners are gone during work or school day?
Outside in Kennel
Outside on chain
Loose in house
Confined area in house
Other

If other, please explain

On average, how many hours will the dog spend alone each day without human companionship?

Do you plan on obedience-training your dog?
Yes
No

If yes, on your own or in classes?

What problems could constitute a reason for giving up your dog?

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