Animal Adoption Form     Animal Preference: Click on Arrow Puppy Kitten Adult Dog Adult Cat Are you interested in a specific pet? If so, what is the name and/or Pet ID? Have you considered the advantages of an adult dog/cat over a puppy/kitten? What type of animal are you interested in? If you could choose your ideal pet, what would it be? Are there any particular breeds or characteristics that you like? Are there any particular breeds or characteristics that you dislike? Would you consider adopting a special needs animal (i.e. blind, 3 legged, timid)? II. Information about adopter/applicant: Name: Address: City: State: West Virginia Alabama Alaska Arizona Arkansas California Canada Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. Wisconsin Wyoming Zip Code: Home Phone: Work Phone: E-mail: Are you 18 years of age or older? Click on Arrow Yes No Can you present current identification with a current address listed? Click on Arrow Yes No Have you talked with, and do you have the consent of, ALL adults in your household to bring this pet home? Click on Arrow Yes No Is this animal for you and your family? Click on Arrow Yes No What is your motivation for getting a pet at this time? Are you aware of the time and money necessary to provide for the training, medical treatment and proper care of this new pet? Click on Arrow Yes No Do you have the time and money necessary to provide for the training, medical treatment and proper care of this new pet? Click on Arrow Yes No Do you understand that MCAL has the right to approve or deny this adoption application? Click on Arrow Yes No How did you hear about MCAL? Have you contacted MCAL before? Click on Arrow Yes No Do you live in a house, apartment, townhouse, mobile home? Please describe. Do you rent or own? Click on Arrow Rent Own If you rent, please provide your landlord's name and phone number. Are you planning to relocate in the next thirty days? Click on Arrow Yes No How many adults and children are in your household? Adults:    Children (list ages): How many pets do you have at home at the present time? (include the type of animal, name, age, sex, whether spayed or neutered) Has your pet been given annual vaccinations this year? Click on Arrow Yes No If you currently own a dog, where is the dog kept during the day and at night? If you own a dog, has it been kept on heartworm preventative? Click on Arrow Yes No Please provide your Veterinarian information. Vet Name: Clinic/Practice Name: Address: City: State: West Virginia Alabama Alaska Arizona Arkansas California Canada Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. Wisconsin Wyoming Zip Code: Phone: Describe any pets you have had in the last five (5) years but no longer have and explain why you no longer have them. Include whether they were spayed or neutered. Please provide two personal references (name & phone number). III. Care of Adopted Cat: Do you intend to let your cat outdoors? Click on Arrow Yes No Do you intend to declaw your cat? Click on Arrow Yes No What brand of food are you going to give your cat? How often will you groom your cat? IV. Care of Adopted Dog: Where will this dog stay during the day and at night? Where will this dog be kept when left alone? Where will this dog sleep? Do you have a fenced-in yard? If so, height of fence. Do you have a pool? Where and how will you exercise this dog? Will you collar and tag this dog? Click on Arrow Yes No Will you use a leash? Click on Arrow Yes No Will this dog be restricted to or from a certain area? If yes, please describe the area. Do you intend to take this dog to training classes? Click on Arrow Yes No What brand of food are you going to give this dog? How often will you groom this dog? Will this dog be kept on heartworm preventative? Click on Arrow Yes No V. General Care of Adopted Animal: I want to adopt this pet because: If I adopt this pet, it will usually be left alone for     hours a day,     days a week. If you move, do you intend to take this pet with you? Click on Arrow Yes No What would you do if you moved to a location that doesn't allow pets? Are you aware that this pet may live to be 15 years of age or more? Click on Arrow Yes No Are you willing to make this very serious commitment? Click on Arrow Yes No How much money have you allotted for this pet in the next year? Have you ever adopted a pet before? Click on Arrow Yes No Completion of this application form does not guarantee that MCAL will place one of our pets in your care. Completion of this questionnaire authorizes MCAL to verify any information contained herein, including verification of medical records of any present or prior pets treated by the veterinarians listed. Completion of this application is an indication that you have read, understand and agree to abide by our Animal Adoption Agreement. All adoptions are at the sole discretion of Monroe County Animal League.