We
hope you will find the right family pet. Please fill out the following
application carefully and completely. The application is designed to help us
make the best placement possible for the pet and adopter.
PLEASE READ THE FOLLOWING SECTION CAREFULLY. IN ORDER TO BE
CONSIDERED AS AN ADOPTER YOU MUST:
Please initial here that you have read and understand the
above adoption requirements and that you meet, or agree to meet the
requirements within a reasonable length of time: __________________ Date:
__________
What animal(s) you are interested in:_________________________________________________________
Where did you see this (these) pet(s)? __ Greentab __ Other Newspaper Ad __ Petfinder.com
__ Other (If Other,
please explain:_________________________________________________________)
If you’re not from our local area, are you willing to come
here to pick the animal up? __________________
Would it be a week day or weekend pick-up?
_________________________ Note: We do NOT fly animals!
If you did not find the pet you would like to adopt today,
please let us know what you are looking for:
_______________________________________________________________________________________
Personal
Information:
Name:____________________________________ Driver’s License
#___________________ Its State: ____
Address___________________________City_________________________State________Zip___________
(If rural address, please draw a map on the back of the
application with directions.)
Home Phone #_______________ Work Phone #______________
E-mail Address ______________________
Are you the owner of the home? _____ If not, who is? Name ______________
Contact Info _______________
Landlord’s name____________________________________________
Phone #________________________
Do you live in the city? ______ or in the suburbs? _____ In a house?_______ or in an
apartment?__________
How long have you lived there? _____________ Are you planning to move in the next 6
months?___________
If so, what are your plans for the
pet?___________________________________________________________
What hours is someone usually home?
_____________________ Number of people
in your home?_________
Any children under the age of 18? _________ If yes, what
ages? _____________________________________
Does anyone in your household have allergies to animals?
_______ If yes, explain? ______________________
Are you willing to commit to a pet for 10 -15 years ( the
average life span)? ______
Does your family support this decision to bring home a new
pet? ______________________________________
Pet History and
Current Information:
Please fill out the following information for the pets you
have owned in the last 5 years.
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Pets Name |
Where did you
obtain this pet? |
Type of Animal and
Breed |
Age |
Spayed or Neutered? |
How long have you
had it? |
Do you still have? |
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If you do not still have any of the above mentioned animals,
explain what happened to them: _______________
_________________________________________________________________________________________
Have you ever brought an animal to a shelter? ________ If so
what were the circumstances? _______________
__________________________________________________________________________________________
Name and phone # of your current Veterinarian?
___________________________________________________
Prior Veterinarian(s)? (last 5 yrs.) Name and Phone #
_______________________________________________
May we contact present and/or prior vet(s)? ________ If
not, why not? __________________________________
Who’s name is the pet listed under at the vets?
____________________________________________________
Are you able and willing to provide necessary medical
attention for your pet as long as you own it? ____________
Do you agree to have your pet spayed or neutered within 30
days of adoption or by the age of 6 months? ______
If it’s a female, do
you agree to not to let it have a litter? ______
Why do you wish to adopt a pet? (Check all that apply)
Companion _____ Guardian_____ Mouser _____ Gift ______ For children _____ Other ___________________
What temperament do you prefer? (Check all that apply)
very active ____
protective ____ intelligent
____ Independent ____ active____
playful ____
easy-going ____ lap
dog/cat ____affectionate ____ sedate ____ shy ____ other ____
I would like my new pet to get along with other: (Check all
that apply)
dogs ___ cats ___ birds ___ rabbits ___ farm animals ____
Where will your pet spend most of its time? Inside ____ Outside ____
Do you have: (check all that apply)
A fenced in yard ___________ A pet door __________ An
outdoor kennel or run _________
An over-head cable ________ A
dog house ___________ A tie-out
_________
What method of house training do you plan to use?
_________________________________________________
Have you ever crate trained a
pet? ______________________________________________________________
Where will the pet sleep? ________________ If you’re not
home, where will the pet stay? __________________
If you adopt a cat, are you planning to declaw it? ______
May we visit you home in the future to verify the pet’s well
being? ______________________________________
I hereby certify that all information in this application is
true and correct to the best of my knowledge.
________________________________________________________ _______________________
Signature
Date
_________________________________________________________ _______________________
WCAS Witness
Date
Adoption Status:
Office use only: Approved
_______ Disapproved_______
Reasons:______________________________________________________________________Revised
10/2005