Name:

Address:

City:

State:

Zip:

E-mail:

Daytime Phone:

Please include area code.

Evening Phone:

Please include area code.

Best Time & Place To Call:

Which available animal are you interested in adopting?  If you have no specific animal in mind, please tell us what kind of pet you want to adopt; Your preferences with regard to breed, sex, age, color, personality etc:

Who is this animal for?  

Please provide a description of your experience with animals. Please include any experience with training or special activities.

Have you ever had to give up a pet before? What were the circumstances?

What is it about this particular animal or breed that has generated your interest? 

What other breeds have you considered?

What animals currently live in the household? (Please list.  Include the following info for each pet: Name of pet, type of pet, sex/age, How long owned?  Kept where?)

Have you had any complaints about your pets?  Yes  No
If yes, please explain.

Are the above animals current on vaccinations & heartworm preventative? Yes  No

Are the above animals spayed or neutered? Yes  No

Are the above animals friendly with other animals? Yes  No  

Do you intend to keep your new pet primarily indoors or outdoors?  Please elaborate.

Where will your new pet sleep at night? 

Approximately how many hours a day will he or she be alone?  
3 hours or less  3-6 hours  6-9 hours  9-12 hours over 12 hours

Approximately how many hours a day can you spend with the dog?

What would be your response if your new pet made a mistake?

Are you financially prepared to give your new pet the routine medical care it will require? Yes  No
Have you carefully considered how adopting this pet will fit into your lifestyle?Yes No
What kind of food do you plan on feeding your new pet?

Which of the following best describes your current residence? (Check one)
Own Home  Rent/Lease Home  Rent/Lease Apt or Condo Other

Do you have a fence?  No  Yes  Type of Fencing
Fence Height    Type of Gates
Is fence solid & secure?  No  Yes  Can children open gates?  No  Yes

Please list the people that currently live at your residence.
(Please list relationship to you & their age.  We don't need the children's names.)

Has your family discussed the pros & cons of adopting an animal?Yes  No
If you have children are you willing to teach them the proper way to handle a new animal? Yes  No
Does everyone in the family want to adopt this animal?  Yes  No
What is your family's overall reaction to adopting this pet?

Does anyone in the household have any known allergies to animals?Yes No  If yes, please explain.

Do you have a veterinarian you have used before?  Yes  No

Vet Name and Phone Number Please include area code.

Any other comments you'd like to add for consideration of your application to adopt?

We reserve the right to inspect all homes and yards prior to approving any adoption.  Is this okay?  No    Yes

Would you consider volunteering for our organization  Yes  Not At This Time
If yes, which of the following areas interest you?
Foster Care   Personal interviewing of adoption candidates   Fundraising   Home Visits
Transporting   Computer Assistance  Telephone calling  Representing us at an Adoption Event
Other   PLEASE SPECIFY  

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