ADOPTION APPLICATION

 

 

DATE______________________TIME_________________________________________

 

NAME & GA. DRIVERS LICENSE #__________________________________________

 

STREET ADDRESS_____________________________ CITY______________________

 

HOME PHONE___________________________WORK PHONE____________________

 

PLEASE CIRCLE ONE

 

CITY RESIDENT        COUNTY RESIDENT        OUT OF COUNTY RESIDENT

 

DO YOU:            RENT?            OWN?

 

IF YOU RENT, PLEASE LIST APARTMENT COMPLEX AND PHONE#_____________

 

NAME_________________________________PHONE____________________________

 

IF YOU RENT, DOES YOUR LEASE ALLOW PETS?                       YES                        NO

 

DOES YOUR LEASE REQUIRE A PET DEPOSIT?                            YES                        NO

 

IF YES, HAS THIS DEPOSIT BEEN PAID?                                        YES                        NO

 

IS THERE A WEIGHT OR SIZE RESTRICTION?                               YES                        NO

 

WILL THE ANIMAL BE KEPT OUTSIDE?                                        YES                        NO

 

IF YES, DO YOU HAVE A FENCE?                                                   YES                        NO

 

WHAT IS YOUR REASON FOR ADOPTING A PET?_____________________________

 

__________________________________________________________________________

 

DO YOU HAVE PETS IN YOUR HOME NOW?                                YES                       NO

 

IF YES, WHAT PETS DO YOU HAVE? ________________________________________

 

__________________________________________________________________________

 

ARE ALL DOGS & CATS SPAYED OR NEUTERED?                       YES                        NO

 

ARE ALL DOGS & CATS 4 MONTHS OF AGE OR OLDER CURRENTLY VACCINATED/

LICENSED FOR RABIES?                                                                    YES                        NO

 

IS EVERYONE AWARE OF YOUR INTENTION TO ADOPT?         YES                        NO

 

ARE THERE ANY CHILDREN IN YOUR HOUSEHOLD?                  YES                        NO

AGES?___________________________________________________________________

 

DOES ANYONE HAVE ALLERGIES TO ANIMALS?                        YES                        NO

 

WHAT VETERINARY CLINIC ADMINISTERED THE RABIES VACCINATION?____

 

_________________________________________________________________________

 

PLEASE LIST ALL PETS YOU HAVE OWNED IN THE PAST FIVE YEARS AND EXPLAIN WHAT HAPPENED TO THEM._____________________________________

 

_________________________________________________________________________

 

ARE YOU PREPARED TO PROVIDE YOUR ADOPTED PET WITH THE NECESSARY

VETERINARY CARE?                                                                        YES                        NO

 

WHO WILL BE RESPONSIBLE FOR THE CARE OF THIS ANIMAL?______________

 

_________________________________________________________________________

 

HAVE YOU EVER RECEIVED A CITATION OR HAD AN ANIMAL IMPOUNDED BY

THIS DEPARTMENT?                                                                        YES                        NO

 

ARE YOU AWARE THAT THE PET YOU ARE ADOPTING MUST BE SPAYED OR NEUTERED ACCORDING TO GEORGIA LAW?                           YES                 NO

 

THANK YOU FOR TAKING THE TIME TO FILL OUT THIS APPLICATION.  THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE.

 

PRINT NAME:_____________________________________________________________

 

SIGNATURE:______________________________________________________________

 

 

                                                       OFFICE USE ONLY

 

CIRCLE ONE               APPROVED                        DISAPPROVED                        PENDING

COMMENTS_______________________________________________________________

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