Adoption Application

Adopter Information

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Home Phone

Cell Phone

Email address *

Employment Information

Occupation

Name of Employer

Work Address

Address Line 1

City

State

Zip Code

Phone

Work Hours

How long have you worked here?

Does your work require travel?

Yes
No

If you are not currently employed, please explain:

Personal References

Please provide two references, preferably people with pet(s) that you have interacted with, and that do not live with you.

1. Reference

1. Reference name

First and Last Name

1. Reference relationship

Relationship (not in household)

1. Reference phone

Phone Number

2. Reference

2. Reference name

First and Last Name

2. Reference relationship

Relationship (not in household)

2. Reference phone

Phone Number

Veterinarian Reference

What is/was your veterinarian's information:

Veterinarian Name:

First

Last

Veterinary Practice:

Veterinary Address

Address Line 1

City

State

Zip Code

Veterinary Phone:

If you do not currently have a veterinarian, where do you anticipate taking your pet for care? Please Explain:

Pets In Household

Please list your pet(s) and/or other animals that currently live in your home, regardless if the animal belongs to you or someone else.

Name - Type of Animal & Breed - Age - Sprayed/Neutered - How long is with you?

Previous Pets

If you previously have had pets, please complete the pet history for each animal.

Name of pet(s):

What type of animal:

Where did you get this pet?

If the pet was adopted, what organization did you adopt from?

Was this pet spayed or neutered?

What is/was the name(s) and phone number(s) of the pet's veterinarian?

How often did this pet go to the veterinarian?

What happened to this pet?

Household Information

Unless you live alone, list the people in your household. Please note all members of the household must be in agreement concerning the adoption of an animal.

First and Last Name - Relationship - Age (if under 21) - Phone Number

Do you, or any members of your household, have allergies to animals?

Yes
No

If "Yes" please Elaborate:

Have you considered budgeting for your pet's expenses such as: food, bedding, grooming, outerwear, pet sitters/walkers, annual veterinary care, emergency or urgent care and other unexpected health expenses that can incur?

Yes
No

Are you familiar with humane procedures for housebreaking?

Yes
No

If a behavior problem arises, are you prepared to invest the time and expense for professional training?

Yes
No

If you have to travel, who will care for your pet while you're away? Please Explain:

Housing Information

We require documentation your building allows animals. Does your residence permit pets?

Yes
No

Do you own or rent?

Own
Rent

What option best describes your living situation:

Apartment
Condo/Co-op
House

Do you have screens on all of your windows?

Yes
No

Do you have a yard?

Yes
No

If yes, is your yard fenced in?

Yes
No

Do you have balcony or terrace?

Yes
No

Is your balcony/terrace pet secured?

Yes
No

If "Yes" - Please Explain:

Does your building have stairs?

Yes
No

Does your building have an elevator?

Yes
No

Do you live in a house with stairs?

Yes
No

Do you agree to a have an adoption specialist visit your home and ensure the environment is safe for a pet?

Yes
No