Name *
Street Address *
City, State *
Zip Code *
Phone
Email *
Name of pet that you are interested in
Where are you employed*
Occupation *
Work Phone *
Spouse's Name *
Spouse's Occupation *
Our adoption process includes a home visit. Are you willing to let a representative visit your home by appointment? *
If you answered no to the previous question, please explain.
Personal non-family reference #1 (Name, Phone, Relation) *
Personal non-family reference #2 (Name, Phone, Relation) *
What is your reason for wanting to adopt a pet at this time? *
Description of residence *
Do you... *
If you are renting, what is the name of the property, property owner, and phone number? *
Does your Homeowners Association have any restrictions on pet ownership?
If you answered "YES" Above, Please Explain.
Do you have a fenced yard? *
Fence Height *
Number of adults in the house *
Number of children in the house *
Who will care for this dog? *
Where will you keep the dog during the day? *
Where will you keep the dog at night? *
Where will you keep the dog while you are away? *
On average, how many hours will the pet spend alone? (please specify daily or weekly) *
On average, how many hours will the pet spend outside by itself? (Please specify daily or weekly)
How will you handle this pet's exercise and potty breaks? *
Please list all animals currently living at your address and any pets you have owned in the last three years: (please include age, species, breed, and sex) *
Spayed/Neutered *
If you answered "no" to the above question, please explain.
Vaccinated *
If you answered "no" to the above question, please explain.
What happened to the pets that are no longer with you? *
If adopting a dog, will you obedience train the dog? *
Please describe the extent of care that you are willing to provide should your pet have special medical needs now or later in life. *
Will you have your pet vaccinated annually by a veterinarian?
Please describe what you know about the causes and prevention of heartworms. *
How will your pet be cared for when you are out of town? *
If you currently have a veterinarian, please provide the name, address and phone number. *
Have you owned this breed/mix before?
Have you owned a rescued animal before?
Have you ever adopted from a rescue group or shelter? *
If "yes", please provide the name of the rescue or shelter.
Have you applied to adopt an animal and been declined? *
If "yes" please explain.
Have you ever given up an animal? *
If "yes", what did you do with the animal(s) and why? *
What qualities are you looking for in a pet? *
What traits or characteristics are you sure you do NOT want? *
