The following information is requested from you so our staff may assist you in the selection of a new pet. The process is designed to help us determine if the adoption is in the animal's, and your family's, best interest and to assist you in finding the right pet to fit your lifestyle.
In order to be considered as an adopter you must:
* Be 18 years or older.
* Have identification showing your current address.
* If renting, have consent from your landlord.
* Be willing to commit the love, time, money and effort required of a pet owner who adopts from us.
1. I am here to look for a ( ) Puppy ( ) Dog ( ) Kitten ( ) Cat ( ) Other
Specific Breed(s)________________________________ Mix? ( ) Yes ( ) No
Sex Preference ( ) Male ( ) Female ( ) Either
2. Where do you plan to keep your pet? ( ) Inside Only ( ) Outside Only ( ) Both
When out, will pet be kept in:
( ) Fenced Yard (Chain link/Invisible/Other)
( ) Kennel/Pen Size ______x______
( ) Run loose
( ) Chained or on Runner
( ) Other (explain)__________________________________________________
3. Is this your first experience with a pet? ( ) Yes ( ) No
Have you adopted from us before? ( ) Yes ( ) No
4. Please check the following reason for a pet:
( ) Watchdog ( ) Companion ( ) Barn Cat/Mouser ( ) Hunting ( ) Family Pet
( ) Child's Pet Other Pet's Companion ( ) Business Watchdog
( ) Other__________________________________________________
5. Do you currently have other pets? ( ) Yes ( ) No
Name______________________ Species/Breed_________________________
Age__________ Sex(S/N?)_________________ Declawed___________
Name______________________ Species/Breed_________________________
Age__________ Sex(S/N?)_________________ Declawed___________
Name______________________ Species/Breed_________________________
Age__________ Sex(S/N?)_________________ Declawed___________
6. How many dogs/cats have you owned in the past 5 years? Dogs___Cats___
What happened to those pets?
Name____________________Species/Breed_________________Age_______
________________________________________________________________
Name____________________Species/Breed_________________Age_______
________________________________________________________________
Name____________________Species/Breed_________________Age_______
________________________________________________________________
7. Who is your veterinarian?____________________Phone#_______________
Do we have your permission to contact this vet as a reference? ( ) Yes ( ) No
8. Do you currently live in a ( ) house ( ) apartment ( ) mobile home ( ) duplex?
Do you ( ) own ( ) rent ( ) live with parents?
9. If you rent, does your lease allow pets? ( ) Yes ( ) No
Are there size specifications? ( ) Yes ( ) No
Explain___________________________________________________________
10. If you rent, what is your landlord's name?____________________________
Phone#______________ Do we have your permission to contact? ( ) Yes ( ) No
11. How many people live in your household?________
Name_______________________________________ Age_______ Sex______
Name_______________________________________ Age_______ Sex______
Name_______________________________________ Age_______ Sex______ Name_______________________________________ Age_______ Sex______
Name_______________________________________ Age_______ Sex______
Your Name_____________________________________Date_______________ Address__________________________________________________________
City_______________________________State_______Zip_________________
Phone: Home________________ Work______________ Cell_______________
