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Adoption Application
Name :
Address:
City/State/Zip:
Phone Number:
Days:
Evenings :
Cell:
E-mail Address:
Occupation of all adults in household:
1.
2.
3.
4.
How long at this address:
Rent or Own:
If renting, does your landlord allow pets?
Landlord's name and phone number
to verify above:
If you move, what will you do with this animal?
Where will the pet be kept:
during the day?
during the night?
when no one is home?
when you are on vacation?
Rate the activity level of your household:
Very quiet:
Moderate activity:
Controlled chaos:
Non-stop activity:
How long will the pet be left alone each day?
Exercise and elimination: (choose yes or no)
On a lead? Yes No On a chain or trolley? Yes No Totally enclosed fenced in yard? Yes No Partially fenced in area? Yes No Electronic/radio fence? Yes No Loose in yard? Yes No Indoor potty area (ex. papers, box)? Yes No
How many adults live in the household?
Their ages?
How many children live in the house?
Their ages?
How many children visit regularly (grandchildren, etc.)?
Their ages?
Who will be responsible for caring for this animal and their age?
References will be checked:
Veterinarian's Name:
Address:
Phone:
May we contact?
Name of person vet records are filed under:
Please list two other references (not relatives) we may contact regarding this adoption:
Name:
Phone #:
Relationship:
Name:
Phone #:
Relationship:
Please list all the animals you have owned in the past 5 years (if none, include pets you have owned during your adult life)
Type (cat, dog, etc.) & Breed:
Age, Gender, Spayed/Neutered:
How did you obtain?
Where is animal now?
Type (cat, dog, etc.) & Breed:
Age, Gender, Spayed/Neutered:
How did you obtain?
Where is animal now?
Type (cat, dog, etc.) & Breed:
Age, Gender, Spayed/Neutered:
How did you obtain?
Where is animal now?
Type (cat, dog, etc.) & Breed:
Age, Gender, Spayed/Neutered:
How did you obtain?
Where is animal now?
Have you ever lost a pet or had one die prematurely due to an accident?
Please provide details:
Have you ever given a pet up or away?
Please provide details:
How much money do you plan to spend on this animal each year?
Consider food, vet care, boarding, flea/tick prevention, heartworm prevention, etc.
What do you know about heartworm prevention and it's importance?
What do you know about flea/tick control?
What do you know about changing an animal's diet/food?
The following questions are to help us determine what type of dog you are looking to adopt. Please indicate if your answer is "a preference" or a "must-have" when applicable.
Are you interested in adopting a male or female?
How old of a dog are you interested in adopting?
Would you consider a dog:
Over 3 years old?
Over 6 years old?
Over 10 years old?
Would you consider a dog that is not housebroken?
Would you consider a dog with health problems?
Would you consider a dog with some behavioral problems?
Is size and appearance important?
If so, explain?
Name of animal you are interested in:
Do you agree to return this dog to Pick-A-Pet Adoptions, Inc. if you are unable to keep it for any reason? Very important that you understand!
Pick-A-Pet Adoptions, Inc. reserves the right to refuse any application for any reason
By signing below, I certify that the information listed in this application is true and accurate.
D.L.#/State Issued/Exp. Date:
Signature:
Date:
Additional Information: (if applicable)
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