Pet Adoption Application

All information entered will only be used toward your adoption and is strictly confidential. If there is a particular pet that you are interested in, please indicate the pet's name in the comments section at the end of this application.

Name: Marital Status: Address: City: State: Zip: Telephone: Employer: Job Title: Work Telephone: Email Address:

Household Information Do you live in an: apartment condo townhouse house duplex mobile home villa Do you: rent own How long have you lived at the above address: Is your lease: annual month-to-month week-to-week Are pets allowed? no yes unknown Name & Telephone Number of Landlord: How many adults reside in household: How many children?: Ages? How many grandchildren? How often do they visit you? Is anyone home during the day? yes no. If yes, who will be home? May we visit your home? yes no Are you financially prepared to provide the necessary care for your dog including: proper food, vaccinations, parasite control (fleas, ticks, worms, etc.), licensing, adequate shelter, and veterinary care for yearly check-ups, or an after-hours medical emergency or illness, which could cost $500 or more? yes no.

Pet Ownership History Have you ever brought an animal to a shelter? yes no If yes, why? Please list any pets you have now or have had in the last six years: Name of Pet: Type of Pet: Breed & Sex: How long with you: What happened: Name of Pet: Type of Pet: Breed & Sex: How long with you: What happened: Name of Pet: Type of Pet: Breed & Sex: How long with you: What happened: Name of Pet: Type of Pet: Breed & Sex: How long with you: What happened: If you have pet(s) now are they spayed or neutered: yes no Are they: indoors outdoors both Are they up to date on vaccines? yes no. Are they on heartworm preventative? yes no. Comments: Has anyone in the household ever had an allergy to animals? yes no.

Accomodations Would your new pet live: indoors outdoors both. Do you have a dog-secure fenced area: yes no Where will he(she) sleep: Where will he(she) be when nobody is home: When you're at home: Which will you provide for your new pet: patio porch doghouse crate/cage Other: Have you ever used a crate to train a pet? yes no. Any objection to doing so if needed, (i.e. to prevent unwanted chewing electric cords, furniture behavior; or health problems that might occur; for further house breaking of a shelter pet; to medicate urinary tract infection, etc.)? yesno. Approximately how many hours a day will your companion animal be alone: 3 hours or less more than 3 but less than 6 more than 6 but less than 9 more than 9 but less than 12 more than 12 but less than 18

Veterinarian Name: Phone: Address: City: State: Zip:

Pet Preferences What kind of temperament are you looking for in a pet: What age pet would you prefer: What sex do you prefer: Would you consider a pet with special needs: yes no. Why do you want to adopt a pet: Be as thorough as possible! Are you willing to COMMIT yourself and your energies to this pet for his lifetime? yes no. Additional Comments:

I affirm that all information above is true. I realize that this is a lifetime commitment and will endeavor to give this pet a happy & healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTEE FOR ASSISTANCE, OR IF I MUST GIVE IT UP, I WILL RETURN IT TO THE FOSTER HOME. WHILE CONSIDERING THIS ADOPTION, I WILL HOLD THE ADOPTEE AND THE FOSTER HOME HARMLESS FOR ANY PHYSICAL, MEDICAL OR PERSONAL PROPERTY DAMAGE.: SIGNATURE: Date:

If you have any problems with the online application, please email us at bonniea15@earthlink.net with your name and phone number and we will follow up with you as soon as possible.