COMPANION ANIMAL PLACEMENT
Hoboken, NJ
Adoption Application


Thank you for your interest in adopting a pet from Companion Animal Placement. We have many wonderful
and healthy animals in our care who are just waiting to bring affection and play into your home.
We make every effort to evaluate each companion animal's personality and preferences so that we can make
a good match to your lifestyle and other pets. To help us make the best placement, we ask that you fill out
this questionnaire. Use the tab key to move between fields. (Only completed applications will be processed.)
Application Type: Dog      Cat Name of Animal:

If you do not have your heart set on a particular animal and would consider others, please tell us what you
are looking for: e.g., cat/dog, age, breed, size, declawed, good with children, special needs, etc.
Please note: Kittens can only be adopted in pairs; this is important for their proper socialization.

Personal Information: (* = Required)
Name: *
Address: * City: *
State: * Zip: *
Home Phone: * Email: *

Household Information: (* = Required)
What type of housing do you currently live in? * Single Family Condo/Coop/Twnhs Apt
How long have you lived at your current address? *
Do you rent or own? * Rent Own
If renting, does your landlord allow pets? * Yes No N/A
If renting, may we contact your landlord? * Yes No N/A
Landlord's Phone Number: (include area code) * N/A  
Number of adults in household? *
Number of children in household? * N/A  
Ages of children? * N/A  
Is anyone in your household allergic to pet hair/dander? * Yes No
Does anyone in your household smoke? * Yes No
Are your windows screened? * Yes No
If you live in an apartment/coop/condo, do you have a terrace? * Yes No N/A
If you live in a house, do other animals enter your house or yard? * Yes No N/A


Please list current and past cats or dogs you've had.
Cat Dog Female Male   Age Spayed Neutered Inside  Both Outside How long with you?  Where is the pet now?
Cat Dog Female Male   Age Spayed Neutered Inside  Both Outside How long with you?  Where is the pet now?
Cat Dog Female Male   Age Spayed Neutered Inside  Both Outside How long with you?  Where is the pet now?
Cat Dog Female Male   Age Spayed Neutered Inside  Both Outside How long with you?  Where is the pet now?
Cat Dog Female Male   Age Spayed Neutered Inside  Both Outside How long with you?  Where is the pet now?

Dogs Only:
Do you have a fenced yard? Yes No
What is the height of the fence? N/A 
How do you plan on exercising the dog?
Hours per day the dog will be left alone?
Do you plan on using a dog crate? Yes No
Who will be primarily responsible for the care of the dog?
Where will the dog spend most of its time?
If you have dogs now are they up to date on vaccinations? Yes No N/A
When vacationing or traveling who will care for the dog?

Cats Only:
Do you plan to allow the cat/kittens to go outside? Yes No
Have you ever had a cat declawed? Yes No
Do you plan on declawing the new cat/kittens? Yes No
If you have cats, are they declawed? Yes No N/A
If you have cats, have they been tested for FeLV and FIV? Yes No N/A
  Test Results
If you have cats, are they up to date on vaccinations? Yes No N/A
Who will be primarily responsible for the care of the cat/kittens?
Where will the cat/kittens spend most of thier time?
Hours a day the cat/kittens will be left without humans around?
When vacationing or traveling who will care for the cat/kittens?

Veterinarian Information: (for current or past pets you've had)
Vet's Name:
Clinic/Hospital Practice:
Phone Number (with area code):
Address:
City/State/Zip:
Name(s) records are under:

Personal Reference: (someone, not a family member, who has seen you interacting with animals)
Name:
Phone Number (with area code):
Relationship:

Comments: (please tell us anything else you would like us to know)

(* = Required)
When will you be able to take this animal? *
If you are unable to keep this animal, do you agree to return it to this organization? * Yes No
May we visit your home? * Yes No
May we call you in the future for reports on the animals adjustment to its new home? * Yes No
Some dogs and cats live 15-20 years. Are you willing to make the long-term commitment to a companion animal's care? * Yes No

I certify the above to be true and complete to the best of my knowledge.

We reserve the right to refuse any application.


Signature (if printing out) ____________________________________ Date ______________