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Applicant's Information |
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| Name
of the dog you are considering: |
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Date: |
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Your Name: |
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Address: |
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Address 2: |
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City: |
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Zip Code: |
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| Home
Telephone: |
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Work
Telephone: |
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Cellular: |
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Occupation: |
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Email
Address: |
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Pre-Adoption Questions |
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Have you
ever owned a dog/cat? |
No
Yes
- Dog
Yes
- Cat
Yes
- Both |
Are you
adopting for you or someone else? |
Myself
Someone
Else
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What
member of the family will be taking the
MAJOR responsibility for caring for this
pet? |
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List the
name(s)/age(s) of the members of your
household: |
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Name |
Relationship to You |
Age |
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Are you
financially able and willing to provide
annual check-ups, vaccinations and any
medical care necessary if your pet
becomes sick or injured? |
Yes
No |
| Is
anyone home during the day? |
Yes
No |
If so,
who? |
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If you are
not home during the day, have you
considered adopting two similar pets to
keep each other company? |
Yes
No |
| Where
do you plan on keeping your pet while
you are at work or not at home: |
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Does
anyone in your household have allergies
or asthma? |
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Type of
housing: |
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Name of
development: |
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| Does
your association permit pets? |
Yes
No |
Is
there a weight limit? |
Yes
No |
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Is there a
deposit required? |
Yes
No |
If yes,
how much? |
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| Own or
Rent? |
Own
Rent |
If you
rent, do you have permission to have
pets? |
Yes
No |
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If
necessary, may we contact your landlord? |
Yes
No |
Please
provide name and telephone number: |
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| Do you
have a fenced in yard? |
Yes
No |
Do you
have a pool? |
Yes
No |
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Do you
have a balcony? |
Yes
No |
Do you
have a screened patio? |
Yes
No |
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If
apartment/condo, what floor do you live
on? |
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Please
describe those pets that are currently
living with you including their name: |
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# of dogs: |
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Breed(s)/Age(s): |
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Neutered/Spayed? |
Yes
No |
Vaccinated? |
Yes
No |
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# of cats |
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Breed(s)/Age(s): |
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Neutered/Spayed? |
Yes
No |
Vaccinated? |
Yes
No |
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Please
describe those pets that formerly lived
with you including their name:
(Going back at least 5 years) |
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# of dogs: |
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Breed(s)/Age(s): |
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Neutered/Spayed? |
Yes
No |
Vaccinated? |
Yes
No |
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Why are
they no longer with you and if they
passed away, what was the cause? |
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# of cats: |
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Breed(s)/Age(s): |
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Neutered/Spayed? |
Yes
No |
Vaccinated? |
Yes
No |
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Why are
they no longer with you and if they
passed away, what was the cause? |
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| Where
did you get your last pet? |
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Have you
ever turned in an animal to an animal
shelter? |
Yes
No |
If yes,
why? |
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| Have
you ever put a dog/cat to sleep for any
reason? |
Yes
No |
If
yes, why? |
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Where do
your current animals live? |
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| Name
of your current or past veterinarian? |
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Telephone number of current or past
veterinarian: |
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What will
you do if your new pet doesn't get along
with your current pets or pet? |
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How long
will you give your new pet to adjust to
its new home? |
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If your
family status changed (new baby,
married, divorced, job loss, relocation,
etc.), who would keep the dog/cat? |
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If
something happens to you and you cannot
take care of your pet(s), who will take
care of the animals? |
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If you
move, what will you do with your pet(s)? |
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When you
go on vacation, where will your pet(s)
go and who will care for them? |
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What do
you think are the most important
responsibilities in owning a pet? |
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References |
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Please
supply the name, address and telephone
numbers of two (2) personal references: |
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Name: |
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Telephone
Number: |
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Address: |
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City: |
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State: |
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Zip: |
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Name: |
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Telephone
Number: |
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Address: |
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City: |
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State: |
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Zip: |
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How did
you hear about us? |
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