Adoption Application

Which cat(s) or dog(s) are you interested in: *

Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Home Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Email *

example@example.com

Your home is: *

House Apartment Condo/Townhouse Other

If you are renting, please provide landlord name and contact info:

Who will be the main caregiver of the cat/dog?

Are all parties of the household on board and willing to help with the care of a new addition? *

Yes No

If adopting a kitten/cat, will you be declawing? *

Check all that apply. Who do you live with? *

Alone Spouse/Partner Roommates Parents Children

Please list name, relationship and ages of all people who live in the household *

Describe the kinds of personal situations where you may have to return your adopted cat, e.g. job loss, children, move, marital change, etc *

Have you or anyone living at the home been charged or convicted of an animal-related crime? *

Yes No

If yes, please explain

Cat/Dog Living Situation and Lifestyle - where will the pet live? *

Inside Outside Combination

If adopting a dog, what type of fencing do you have?

Privacy fence/Physical fencing Invisible Fence No fence

Home setting: *

Urban Suburban Rural

Describe all pets you have owned in the last TWO years:

Name

Type (cat/dog/?)

Breed (if dog)

Age

Sex

Spayed/Neutered

On heartworm preventative?

Indoor/Outdoor

Where is pet now?

If deceased, please explain

Pet 1

Pet 2

Pet 3

Pet 4

Pet 5

Pet 6

Have you ever had an application declined for adoption of an animal from an animal welfare group/animal control center? *

Yes No

If yes, please explain

How many hours per day will your pet be alone?

What kind of veterinary care do you plan to provide?

Vet References

Name of Practice:

Name of Vet:

Phone # of Vet:

Email of Vet:

Any other info that would be helpful for us to know

I have read the above information carefully and have filled out this application truthfully. I understand that omission of information and/or failure to answer all questions and/or sign the application can result in this application being denied.

I understand that my name and date below represent my signature for the purpose of this application

Your full name: *

Date *

Date