Your name: _________________________________________
Your address: _______________________________________
City: _______________________ State: _____ Zip code: ___________
Email Address: _____________________________
Telephone number: (____)________________________
Name of your spouse or significant other (if you have one): __________________________
Other adults living in the home: _________________________________________________
Do you have children, and if so, how many and what ages? ___________________________
Is anyone in your home allergic to animals or suffer from allergies? ____________________
Does anyone in your household smoke? Yes / No
What is your occupation? _____________________________________________________
What is the occupation of your spouse/significant other (if you have one)? ________________
Have you or anyone in your household been accused or convicted of animal cruelty? _______
Who will have responsibility for the animal you want to adopt? _________________________
Has everyone in your home agreed on this pet? Yes / No
If not, whom and why? _____________________________________________________
_________________________________________________________________________
Which pet are you applying for? _____________________________________
Why are you interested in adopting this pet? _______________________________________
___________________________________________________________________________
How long have you been looking for a new pet? ____________________________________
Would this pet be an inside, outside, or in/out pet? ___________________________________
Where will this pet sleep at night? _________________________________________________
Where will this pet stay during the day? _____________________________________________
Who will be responsible for this pet when you are gone (vacation, emergency, etc)? _________
Please include their contact information
How much are you willing to spend on a pet if it becomes injured or sick (please define "appropriate amount" or "within reason")? __________________________________________
How long do you plan on keeping this pet? _________________________________________
How many hours a day will this pet be alone? ______________________________________
How much time will you have for one-on-one time with this pet every day? _______________
Under what circumstances would you return this pet (moving, vet bills, new baby, etc)? _____
_____________________________________________________________________________
Are you aware that there is an adoption fee for this pet? ___________
Are you aware of the requirement to have this pet spayed/neutered if he/she isn't already? _____
Are you willing to pay for the spay/neuter surgery? ________________
Do you know of an obedience class in your area? Yes / No
Are you willing to bring your pet to obedience school? Yes / No
If no, why not? __________________________________________________________
How will this pet be disciplined? ___________________________________________________
_____________________________________________________________________________
Do you have other pets? ________
If so, how many, what kind, ages, genders, where did you get them, how long have you had them? ___________________________________________________________________
_________________________________________________________________________
Are all of your current pets spayed and neutered? ________ If not, why? ________________
____________________________________________________________________________
Have you had pets in the past? Yes / No
If so, how did they die, or why are they no longer with you? ________________________
__________________________________________________________________________
Are you willing to submit a veterinary reference (a written veterinary reference on veterinary letterhead is required)? Yes / No
Are you willing to submit to a home check before and after you adopt? Yes / No
If not, why? _______________________________________________________________
__________________________________________________________________________
Do you own or do you rent your home? _________
If you rent, do you have proof from your landlord that you can have pets (please include a copy or your rental agreement and/or a letter from your landlord as proof)? ___________
If you own your home, are you able to provide proof? _________
How long have you lived at your current residence? ______________________________
Are you planning to move any time soon? Yes / No
If so, why, when and where to? _______________________________________________
__________________________________________________________________________
Is your yard securely fenced? Yes / No
If so, how tall is your fence and what material? ____________________________________
If not, how will potty breaks be handled? ____________________________________________
______________________________________________________________________________