Tysor Veterinary Clinic

*All fields in red are required
	Are you over 21?
	Name:
	Address:
	City:
	State:
	Zip Code:
	Phone:
	Work Phone:
	Cell Phone:
	Email:
	Name of pet(s) you are interested in:
	What is it about this specific pet that appealed to you?
	How did you hear about us?
	ABOUT YOUR HOUSEHOLD
	Do you have children or grandchildren who live with you?	Yes No
	Number of children
	Childrens' ages:
	Please list other residents in your household:
	Are all the pets present in your household up to date on their vaccinations?	Yes No
	Are ALL household members in complete agreement in adopting/caring for the dog?	Yes No
	Do any of your family members have allergies?	Yes No
	ABOUT YOUR HOME
	Are you willing to have a representative from our organization visit your home prior to and/or following adoption?	Yes No
	What type of home do you live in?	If Other-
	How long have you lived at your present address?	Years Months
	If you rent, do you have the permission of your landlord to keep a dog?	Yes No
	Your landlord's name:
	Your landlord's phone:
	May we have permission to contact your landlord?	Yes No
	Will this cat/kitten will be let outside?	Yes No
	Would you consider declawing this cat/kitten?	Yes No If so why?
	Please describe the fencing:	If other-
	YOUR EXPERIENCE WITH PETS
	I consider myself:
	Please describe any pets you currently have:
	Are ALL current pets spayed/neutered?	Yes No
	If you owned a cat before, what happened to your previous cat(s)?
	If your previous pet(s) died, give age and cause of death:
	Have you ever had to give away/sell a cat, kittens or other pet?	Yes No
	If yes, what were the circumstances?
	If you have current pets, or have owned a pet before, may we contact your veterinarian?	Yes No
	Veterinarian name:
	Veterinarian phone:
	Please provide at least one other reference. Name:
	Reference phone:
	Reference relationship to you:
	CARING FOR YOUR CAT
	Who will be the primary caretaker of your cat?
	How long are you gone each day?
	Where will the cat sleep at night?
	Where will the cat be housed during the day when you are home?
	Where will the cat stay while you are gone during the day?
	How often do you travel?
	When you travel, who will care for the cat?
	How will you exercise the cat?
	How much adult supervision of cat and child will be provided?
	With neighborhood children?
	How much responsibility will your child/children be given in the care of the cat?
	Give any reasons why you would not be able to keep this cat/kitten for his/her entire life (potentially 20 years):
	Are you willing to take your cat to a veterinarian to complete any outstanding vetting noted at the time of adoption or needed shortly after the pet arrives in your home?	Yes No
	Are you willing to have your dog tested annually for heartworms and provide monthly heartworm prevention?	Yes No
	Are you willing to take the cat to the veterinarian at least yearly or more often if needed?	Yes No
	A DAY IN THE LIFE...
	Describe what a typical day will be like for this pet if he/she is adopted by you:

COMMENTS

GENERAL AGREEMENT: All of the information I have given is true and complete. I understand that Tysor Veterinary Clinic has the right to refuse my application.