GENERAL ADOPTION FORM

Pet's Name

Your Drivers License Number

Pet's ID#

Date of Birth

Todays Date

Your Name

Current Address

City, State, Zip

Home Phone

Work|Cell Phone

Email

How long have you lived at the address above?

Do you Own or Rent?

OwnRent

Do you live in a. . . .

HouseApartmentCondoMobile HomeDuplexTownhouse

If you lease does your lease allow pets?

YesNoN/A

Is there a pet deposit?

YesNoOption 3

If there is a pet deposit-how much? And is it already paid?

If you lease- What is the name of your Complex and or Landlord

How many people live in the household?

Do you have a roomate?

Do all members of the household know you are planning to adopt a pet?

YesNo

What are the ages of any Children|Grandchildren in the household or that come to the house?

Are you 18years of age or older?

YesNo

Do you live with you parents of other relatives?

Reason for adopting this Pet?

Child's PetFamily PetCompanionWatch DogGuard dog for BusinessBreedingHunting Dog

Are you or your spouse currently employed or retired?

WorkingRetired

Are you interested in adopting for. . .

YourselfFamilySomeone Else

Will an adult be home during the day?

YesNoPart of the day

What is the longest period of time the pet would be home alone on the average day?

Who will be responsible for taking care of the pet?

If adopting a dog or puppy, what procedures will you use for housebreaking?

Crate TrainingNewspaperRubbing NoseSwatting wtih NewspaperOutside OnlyOther

Please explain other

If adopting a dog or puppy, how will you handle scratching or destructive behavior?

Loud NoNo CanWater GunSwatting with NewspaperOutside OnlyOther

Please explain other

If adopting a dog or puppy, what plans do you have for basic obedience training?

VideosClassesBooksIn home lessonsNoneOther

Please explain other

How many cats and/or dogs have you owned in the past five years?

Please Note: Breed / Age / Spayed-Neutered / How Long Owned

Do you presently have pet insurance?

YesNo

Are your pets micro chipped?

YesNo

If they are micro chipped- with whom?

If you no longer have some or all of these animals, what happened to them?

Have you ever turned in an animal to an animal shelter?

YesNo

Where will pet stay during the day?

Where will pet stay during the night?

Do you have a fenced in yard?

YesNo

If so, how high is it? And what kind?

If you do not have a fence, how will the dog get exercise and use the bathroom?

For which of the following reasons would you give up your pet?

MovingNew BabyNot getting along with childrenNot getting along with other petsDivorceGetting out of fenceBehavior IssuesChildren lost interestFinancialAggressive BehaviorsGot too bigToo time consumingAllergiesBarkingMedical ProblemsWould never give up the dogOther

Please explain other

If you currently own a dog, is it on heartworm preventative?

YesNo

If yes, what brand?

Do you currently have a Vet? If so, what is the name of your Veterinarian | Veterinarian Clinic?

May we contact Vet?

YesNo

Phone Number of Current Vet.

Would you object to an authorized representative inspecting the animal and premises where the animal is being kept?

YesNo

Applicant Acknowledgement- By checking this box you acknowledge all information provided is true and accurate.

Yes

Date Application completed

Adoption Questions

Verification